Provider Demographics
NPI:1518429356
Name:ZAREMBA, KIAH NICHOLE JACKSON (DDS)
Entity Type:Individual
Prefix:
First Name:KIAH
Middle Name:NICHOLE JACKSON
Last Name:ZAREMBA
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 1:281 WOOD LANDING RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-3534
Mailing Address - Country:US
Mailing Address - Phone:540-207-5417
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:DEPARTMENT OF DENTAL MEDICINE
Practice Address - City:BROOKYLN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program