Provider Demographics
NPI:1598833451
Name:KIMBERLY WILSON PRYZGODA DDS PA
Entity Type:Organization
Organization Name:KIMBERLY WILSON PRYZGODA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRYZGODA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:910-826-8900
Mailing Address - Street 1:653 HAY STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301
Mailing Address - Country:US
Mailing Address - Phone:910-826-8900
Mailing Address - Fax:910-826-2244
Practice Address - Street 1:653 HAY STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-826-8900
Practice Address - Fax:910-826-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty