Provider Demographics
NPI:1134259740
Name:NOZIK, KENNETH D (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:NOZIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1409
Mailing Address - Country:US
Mailing Address - Phone:585-424-5120
Mailing Address - Fax:585-424-1743
Practice Address - Street 1:935 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1409
Practice Address - Country:US
Practice Address - Phone:585-424-5120
Practice Address - Fax:585-424-1743
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0387511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70138OtherEXCELLUS BLUE CROSS