Provider Demographics
NPI:1609614478
Name:KMS DMD, P.C.
Entity type:Organization
Organization Name:KMS DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-476-4766
Mailing Address - Street 1:983 KENILWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8272
Mailing Address - Country:US
Mailing Address - Phone:708-476-4766
Mailing Address - Fax:
Practice Address - Street 1:1450 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5904
Practice Address - Country:US
Practice Address - Phone:708-476-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental