Provider Demographics
NPI:1902202070
Name:ZWASCHKA, NICOLA (RDH,MS)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:ZWASCHKA
Suffix:
Gender:F
Credentials:RDH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-0183
Mailing Address - Country:US
Mailing Address - Phone:970-209-7059
Mailing Address - Fax:
Practice Address - Street 1:1550 E. NIAGARA ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5027
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:970-701-4161
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000201748124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54456258Medicaid