Provider Demographics
NPI:1881752806
Name:KUBICZEK, IWONA ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:IWONA
Middle Name:ELIZABETH
Last Name:KUBICZEK
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 1:2021 EMMORTON RD # B
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6138
Mailing Address - Country:US
Mailing Address - Phone:410-838-4404
Mailing Address - Fax:410-515-1283
Practice Address - Street 1:2021B EMMORTON RD STE 216
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:443-243-2309
Practice Address - Fax:410-515-1283
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029470L122300000X, 1223G0001X
MD116521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist