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General NPI Number Information
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NPI Number | 1417503673
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Entity Type | Individual
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Provider Name | KINGA FIEDORCZUK DMD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 8204 DELTA SHORES CIR S STE 140
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City | SACRAMENTO
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State | CA
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Zip | 95832-9111
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Country | US
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Telephone | 916-277-9069
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 S ST APT 279
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City | SACRAMENTO
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State | CA
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Zip | 95816-7086
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Country | US
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Telephone | 510-299-3468
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 104301
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 104301
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License Number State | CA
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