Provider Demographics
NPI:1669682597
Name:KRISTAL A. IZYDORCZYK, D.M.D., P.C.
Entity Type:Organization
Organization Name:KRISTAL A. IZYDORCZYK, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:IZYDORZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-531-2329
Mailing Address - Street 1:1632 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-3247
Mailing Address - Country:US
Mailing Address - Phone:412-531-2329
Mailing Address - Fax:412-531-8511
Practice Address - Street 1:1632 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-3247
Practice Address - Country:US
Practice Address - Phone:412-531-2329
Practice Address - Fax:412-531-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1765873OtherUNITED CONCORDIA