Provider Demographics
NPI:1336643527
Name:NEDWETZKY, DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:NEDWETZKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NEDWETZKY
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5424 MEADOWPOND DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7093
Mailing Address - Country:US
Mailing Address - Phone:301-693-5704
Mailing Address - Fax:
Practice Address - Street 1:5424 MEADOWPOND DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7093
Practice Address - Country:US
Practice Address - Phone:301-693-5704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist