Provider Demographics
NPI:1093586364
Name:SZEWCZYKOWSKI, KARLA L (RDH BSDH)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:L
Last Name:SZEWCZYKOWSKI
Suffix:
Gender:F
Credentials:RDH BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N71W35506 MAPLETON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1214
Mailing Address - Country:US
Mailing Address - Phone:262-719-4111
Mailing Address - Fax:
Practice Address - Street 1:N71W35506 MAPLETON LAKE DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1214
Practice Address - Country:US
Practice Address - Phone:262-719-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11523-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist