Healthcare Provider Details

I. General information

NPI: 1831170729
Provider Name (Legal Business Name): JOHN B KAZWELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 DUFF AVE
AMES IA
50010-5467
US

IV. Provider business mailing address

1212 DUFF AVE
AMES IA
50010-5467
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-6830
  • Fax: 515-232-3296
Mailing address:
  • Phone: 515-232-6830
  • Fax: 515-232-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7882
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: