Provider Demographics
NPI:1285787796
Name:KUZMA, WALTER DMITRI (DDS)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DMITRI
Last Name:KUZMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 HILBORN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7988
Mailing Address - Country:US
Mailing Address - Phone:707-422-8404
Mailing Address - Fax:707-422-8413
Practice Address - Street 1:3694 HILBORN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7988
Practice Address - Country:US
Practice Address - Phone:707-422-8404
Practice Address - Fax:707-422-8413
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice