Provider Demographics
NPI:1649898016
Name:KUZMIC, KYLE JONATHON (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JONATHON
Last Name:KUZMIC
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11295 WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3732
Mailing Address - Country:US
Mailing Address - Phone:317-833-6185
Mailing Address - Fax:
Practice Address - Street 1:8902 N MERIDIAN ST STE 137
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5306
Practice Address - Country:US
Practice Address - Phone:317-846-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36150122300000X
IN12013748A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist