Provider Demographics
NPI:1245573104
Name:MARELICH, KASIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KASIA
Middle Name:
Last Name:MARELICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATARZYNA
Other - Middle Name:
Other - Last Name:KALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1100 SONOMA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8901
Mailing Address - Country:US
Mailing Address - Phone:707-527-1036
Mailing Address - Fax:
Practice Address - Street 1:1100 SONOMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8901
Practice Address - Country:US
Practice Address - Phone:707-527-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist