Healthcare Provider Details

I. General information

NPI: 1326796095
Provider Name (Legal Business Name): KUZMIC ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
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

2772 GASTON AVE APT 1533
DALLAS TX
75226-2755
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-4446
  • Fax: 317-846-4390
Mailing address:
  • Phone: 317-833-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE JONATHON KUZMIC
Title or Position: OWNER ORTHODONTIST
Credential: DDS, MS
Phone: 317-833-6185