Healthcare Provider Details

I. General information

NPI: 1649898016
Provider Name (Legal Business Name): KYLE JONATHON KUZMIC DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 137
INDIANAPOLIS IN
46260-5306
US

IV. Provider business mailing address

11295 WOOD CREEK DR
CARMEL IN
46033-3732
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-4446
  • Fax:
Mailing address:
  • Phone: 317-833-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number36150
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013748A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: