Healthcare Provider Details

I. General information

NPI: 1396130563
Provider Name (Legal Business Name): KARA NICOLE CIDZIK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 ONEIDA ST
UTICA NY
13501-4866
US

IV. Provider business mailing address

22 BURRSTONE RD
NEW YORK MILLS NY
13417-1508
US

V. Phone/Fax

Practice location:
  • Phone: 315-793-7600
  • Fax:
Mailing address:
  • Phone: 315-525-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number025403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: