Provider Demographics
NPI:1770676645
Name:KIJANKA, GARY (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KIJANKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 N MILITARY TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4601
Mailing Address - Country:US
Mailing Address - Phone:561-776-3116
Mailing Address - Fax:561-776-3165
Practice Address - Street 1:10333 N MILITARY TRL
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-4601
Practice Address - Country:US
Practice Address - Phone:561-776-3116
Practice Address - Fax:561-776-3165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice