Healthcare Provider Details

I. General information

NPI: 1588529606
Provider Name (Legal Business Name): KUZHY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SCENIC HWY
LAWRENCEVILLE GA
30046-6365
US

IV. Provider business mailing address

1204 RED BUD RD NE
CALHOUN GA
30701-9294
US

V. Phone/Fax

Practice location:
  • Phone: 678-215-1300
  • Fax:
Mailing address:
  • Phone: 770-356-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RON S CHEMMALAKUZHY
Title or Position: DENTIST
Credential: DMD
Phone: 770-356-4342