Provider Demographics
NPI:1699843557
Name:PRYZGODA, KIMBERLY WILSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:WILSON
Last Name:PRYZGODA
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 1:653 HAY STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5466
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:28301-5433
Practice Address - Country:US
Practice Address - Phone:910-826-8900
Practice Address - Fax:910-826-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist