Provider Demographics
NPI:1841945490
Name:KAZAK DENTAL CORP
Entity type:Organization
Organization Name:KAZAK DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKIT
Authorized Official - Middle Name:F
Authorized Official - Last Name:KAZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-652-9916
Mailing Address - Street 1:915 SIR FRANCIS DRAKE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1946
Mailing Address - Country:US
Mailing Address - Phone:415-454-5667
Mailing Address - Fax:
Practice Address - Street 1:915 SIR FRANCIS DRAKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1946
Practice Address - Country:US
Practice Address - Phone:415-454-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental