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General NPI Number Information
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NPI Number | 1326148974
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Entity Type | Individual
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Provider Name | NICOLE A. GRESCZYK CRDA/RDA
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Gender | Female
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1789 WOODLANE DR #D
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City | WOODBURY
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State | MN
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Zip | 55125-3910
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Country | US
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Telephone | 651-738-1284
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 FROST AVE UNIT A
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4611
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Country | US
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Telephone | 651-251-3859
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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