Provider Demographics
NPI:1932851854
Name:KWIATKOWSKI, EDWARD W (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:KWIATKOWSKI
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 1:880 CASS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2909
Mailing Address - Country:US
Mailing Address - Phone:831-372-4411
Mailing Address - Fax:
Practice Address - Street 1:880 CASS ST STE 207
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2909
Practice Address - Country:US
Practice Address - Phone:831-372-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0341381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice