Healthcare Provider Details

I. General information

NPI: 1568790418
Provider Name (Legal Business Name): ANNA KULIKOWSKA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 3RD AVE
BROOKLYN NY
11220-3702
US

IV. Provider business mailing address

150 55TH ST
BROOKLYN NY
11220-2559
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6180
  • Fax: 718-630-7437
Mailing address:
  • Phone: 718-630-8092
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number51025813
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: