Provider Demographics
NPI:1811191547
Name:KRZYWICKI, TED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:KRZYWICKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 LAKE CHABOT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5432
Mailing Address - Country:US
Mailing Address - Phone:510-582-1184
Mailing Address - Fax:510-581-1424
Practice Address - Street 1:20600 LAKE CHABOT RD STE 102
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5432
Practice Address - Country:US
Practice Address - Phone:510-582-1184
Practice Address - Fax:510-581-1424
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist