Healthcare Provider Details

I. General information

NPI: 1497853329
Provider Name (Legal Business Name): STEVEN KAZLEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 MONROE AVE
ROCHESTER NY
14618-1417
US

IV. Provider business mailing address

1688 MONROE AVE
ROCHESTER NY
14618-1417
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-3500
  • Fax: 585-244-3796
Mailing address:
  • Phone: 585-244-3500
  • Fax: 585-244-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number036072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: