Provider Demographics
NPI:1962642041
Name:KULICKA-SOBOCINSKI, DOROTA (DDS)
Entity type:Individual
Prefix:DR
First Name:DOROTA
Middle Name:
Last Name:KULICKA-SOBOCINSKI
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 1:25 NEPTUNE BLVD APT 2H
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4643
Mailing Address - Country:US
Mailing Address - Phone:516-771-7777
Mailing Address - Fax:516-771-6080
Practice Address - Street 1:1000 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4247
Practice Address - Country:US
Practice Address - Phone:516-771-7777
Practice Address - Fax:516-771-6080
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics