Healthcare Provider Details

I. General information

NPI: 1710915335
Provider Name (Legal Business Name): ANGELINE ANN KUZNIA III D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 KINGSLEY AVE SUITE 9A
ORANGE PARK FL
32073-4537
US

IV. Provider business mailing address

7928 HAMPTON PARK BLVD E
JACKSONVILLE FL
32256-2945
US

V. Phone/Fax

Practice location:
  • Phone: 904-278-1175
  • Fax: 904-278-1176
Mailing address:
  • Phone: 904-642-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN15267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: