Provider Demographics
NPI:1528410784
Name:MARKIEWICZ, CRISTINA ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:ROSE
Last Name:MARKIEWICZ
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 1:400 S. REINO ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-498-0400
Mailing Address - Fax:805-273-9003
Practice Address - Street 1:400 S. REINO ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-498-0400
Practice Address - Fax:805-273-9003
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003951223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100395OtherDENTAL BOARD OF CALIFORNIA