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General NPI Number Information
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NPI Number | 1710184494
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Entity Type | Organization
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Legal Business Name | DIMITRI KUZNETSOV, M.D. PLLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 1274 7TH ST STE B
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-2404
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Country | US
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Telephone | 360-385-2905
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 7TH ST STE B
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-2404
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Country | US
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Telephone | 360-385-2905
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MARY E. KEYES
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Credential |
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Telephone | 360-385-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State |
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