Provider Demographics
NPI:1235828492
Name:KUZMA, HAILEY LOREN (DMD)
Entity type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:LOREN
Last Name:KUZMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CONVERSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6129
Mailing Address - Country:US
Mailing Address - Phone:910-765-8981
Mailing Address - Fax:
Practice Address - Street 1:3505 CONVERSE RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6129
Practice Address - Country:US
Practice Address - Phone:910-765-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice