Healthcare Provider Details

I. General information

NPI: 1225253586
Provider Name (Legal Business Name): JOHN S KITZMILLER III DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W WILLIAMS ST SUITE 101
APEX NC
27502-3956
US

IV. Provider business mailing address

1021 W WILLIAMS ST SUITE 101
APEX NC
27502-3956
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-1341
  • Fax: 919-362-9656
Mailing address:
  • Phone: 919-362-1341
  • Fax: 919-362-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5719
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN STANLEY KITZMILLER III
Title or Position: OWNER
Credential: DDS
Phone: 919-362-1341