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General NPI Number Information
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NPI Number | 1669682597
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Entity Type | Organization
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Legal Business Name | KRISTAL A. IZYDORCZYK, D.M.D., P.C.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1632 BROADWAY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-3247
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Country | US
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Telephone | 412-531-2329
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Fax | 412-531-8511
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Provider Business Mailing Address
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Address Line | 1632 BROADWAY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-3247
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Country | US
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Telephone | 412-531-2329
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Fax | 412-531-8511
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KRISTAL A. IZYDORZYK
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Credential | DMD
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Telephone | 412-531-2329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS036551
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License Number State | PA
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