Provider Demographics
NPI:1578841151
Name:RADZIWON, ANNA KRYSTYNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KRYSTYNA
Last Name:RADZIWON
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 1:162 NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3389
Mailing Address - Country:US
Mailing Address - Phone:718-389-8889
Mailing Address - Fax:718-389-7502
Practice Address - Street 1:162 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3389
Practice Address - Country:US
Practice Address - Phone:718-389-8889
Practice Address - Fax:718-389-7502
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist