Provider Demographics
NPI:1679658629
Name:WIDAWSKA, LUIZA O (DMD)
Entity Type:Individual
Prefix:
First Name:LUIZA
Middle Name:O
Last Name:WIDAWSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 DONNA JANE CT
Mailing Address - Street 2:APT 108A
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2239
Mailing Address - Country:US
Mailing Address - Phone:704-323-9012
Mailing Address - Fax:
Practice Address - Street 1:1349 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2282
Practice Address - Country:US
Practice Address - Phone:570-622-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice