Provider Demographics
NPI:1447635842
Name:KASIK, KRISTOPHER KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:KYLE
Last Name:KASIK
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 1:159 ALTAMA CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1853
Mailing Address - Country:US
Mailing Address - Phone:912-264-8408
Mailing Address - Fax:
Practice Address - Street 1:159 ALTAMA CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1853
Practice Address - Country:US
Practice Address - Phone:912-264-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0150561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice