Provider Demographics
NPI:1063479236
Name:KWAPISIEWICZ, DOROTA M (DDS)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:M
Last Name:KWAPISIEWICZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5933
Mailing Address - Country:US
Mailing Address - Phone:718-456-2727
Mailing Address - Fax:718-456-2728
Practice Address - Street 1:6007 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5933
Practice Address - Country:US
Practice Address - Phone:718-456-2727
Practice Address - Fax:718-456-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052582Medicaid