1346346053 NPI number — EDWARD W KWIATKOWSKI DDS MARY ANNE MARSCHIK NAWAE OSMAN DDS PROFESSION

Table of content: (NPI 1346346053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346346053 NPI number — EDWARD W KWIATKOWSKI DDS MARY ANNE MARSCHIK NAWAE OSMAN DDS PROFESSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD W KWIATKOWSKI DDS MARY ANNE MARSCHIK NAWAE OSMAN DDS PROFESSION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346346053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 CASS STREET
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-372-4411
Provider Business Mailing Address Fax Number:
831-372-3954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 CASS STREET
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-372-4411
Provider Business Practice Location Address Fax Number:
831-372-3954
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KWIATKOWSKI
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
831-372-4411

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DL034138 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 648090 . This is a "UNITED CON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 648090 . This is a "MILITARY TRICARE" identifier . This identifiers is of the category "OTHER".




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