Provider Demographics
NPI:1285260869
Name:DUDEK, KAROLINA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:MARIA
Last Name:DUDEK
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 1:390 N PACIFIC COAST HWY STE 1050
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4476
Mailing Address - Country:US
Mailing Address - Phone:424-290-3020
Mailing Address - Fax:
Practice Address - Street 1:390 N PACIFIC COAST HWY STE 1050
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4476
Practice Address - Country:US
Practice Address - Phone:424-290-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS106789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program