Provider Demographics
NPI:1215291885
Name:CEJKA, NATHANIEL CONRAD (DDS)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:CONRAD
Last Name:CEJKA
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 1:1780 S FRIENDSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5410
Mailing Address - Country:US
Mailing Address - Phone:281-992-0038
Mailing Address - Fax:
Practice Address - Street 1:1780 S FRIENDSWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5410
Practice Address - Country:US
Practice Address - Phone:281-992-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX392401223G0001X
CODEN-107621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice