Provider Demographics
NPI:1558575472
Name:ADAMCZUK, OPHELIA GARCIA- (DDS)
Entity Type:Individual
Prefix:
First Name:OPHELIA
Middle Name:GARCIA-
Last Name:ADAMCZUK
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 1:8992 MISSION BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2874
Mailing Address - Country:US
Mailing Address - Phone:951-681-6611
Mailing Address - Fax:951-681-6611
Practice Address - Street 1:8992 MISSION BLVD
Practice Address - Street 2:STE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-2874
Practice Address - Country:US
Practice Address - Phone:951-681-6611
Practice Address - Fax:951-681-6611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice