Provider Demographics
NPI:1912937129
Name:KWOLEK, GEMMA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:G
Last Name:KWOLEK
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 1:4949 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1613
Mailing Address - Country:US
Mailing Address - Phone:203-378-9500
Mailing Address - Fax:203-386-9057
Practice Address - Street 1:4949 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1613
Practice Address - Country:US
Practice Address - Phone:203-378-9500
Practice Address - Fax:203-386-9057
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT87341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice