1316956568 NPI number — DR. KEVIN A KIZER DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316956568 NPI number — DR. KEVIN A KIZER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIZER
Provider First Name:
KEVIN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316956568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 W IOWA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83686-2856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-467-5100
Provider Business Mailing Address Fax Number:
208-467-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 LEWISVILLE CLEMMONS RD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-8905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-631-4770
Provider Business Practice Location Address Fax Number:
336-631-4558
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  9266 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805756700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6E060 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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