Provider Demographics
NPI:1518378330
Name:PAPAYA DENTAL ARTS PLLC
Entity Type:Organization
Organization Name:PAPAYA DENTAL ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:IDZIOREK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-964-9702
Mailing Address - Street 1:2101 MADRONA POINT DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2332
Mailing Address - Country:US
Mailing Address - Phone:651-964-9702
Mailing Address - Fax:
Practice Address - Street 1:299 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1893
Practice Address - Country:US
Practice Address - Phone:651-964-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty