Provider Demographics
NPI:1497058713
Name:KORZEC, JADWIGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JADWIGA
Middle Name:
Last Name:KORZEC
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 1:1260 15TH ST STE 701
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1142
Mailing Address - Country:US
Mailing Address - Phone:310-393-7766
Mailing Address - Fax:310-394-8066
Practice Address - Street 1:1260 15TH ST STE 701
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1142
Practice Address - Country:US
Practice Address - Phone:310-393-7766
Practice Address - Fax:310-394-8066
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist