Provider Demographics
NPI:1942408299
Name:KONOPKA, AGATA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AGATA
Middle Name:
Last Name:KONOPKA
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 1:3065 PORTER ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2231
Mailing Address - Country:US
Mailing Address - Phone:831-464-2424
Mailing Address - Fax:831-475-1731
Practice Address - Street 1:3065 PORTER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2231
Practice Address - Country:US
Practice Address - Phone:831-464-2424
Practice Address - Fax:831-475-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice