Provider Demographics
NPI:1477114007
Name:ZAJKOWSKI, IWONA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IWONA
Middle Name:
Last Name:ZAJKOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HEIGHTS TRAIL SE
Mailing Address - Street 2:APT# 223
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741
Mailing Address - Country:US
Mailing Address - Phone:708-691-3030
Mailing Address - Fax:
Practice Address - Street 1:603B MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5937
Practice Address - Country:US
Practice Address - Phone:256-840-2021
Practice Address - Fax:256-840-2864
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0322011223G0001X
AL0006669-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice