Ewa Konopka, DDS – Periodontics in Middletown, CA

Key facts

NPI: 1285844852
Entity type: Individual (NPI type 1)
Primary specialty: Periodontics 1223P0300X
License: 45896 (CA)
Practice address: 21038 Calistoga St.
Middletown, CA 95461-1124
Phone: (707) 987-2773
Fax: (707) 987-0688
NPI assigned: May 23, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Ian Van Zyl BDS,DDS,Ms & Ewa Konopka,DDS,Apc Dentist · Middletown, CA · NPI 1114137775

NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Ian Van Zyl BDS,DDS,Ms & Ewa Konopka,DDS,Apc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Periodontics	1223P0300X	45896	CA	Yes

Addresses

Primary practice location

21038 Calistoga St.
Middletown, CA 95461-1124

Mailing address

PO Box 1124
Middletown, CA 95461-1124
Phone (707) 987-2773

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 2, 2015.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433203200000",
    "number": "1285844852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1124",
            "city": "MIDDLETOWN",
            "state": "CA",
            "postal_code": "954611124",
            "telephone_number": "707-987-2773",
            "fax_number": "707-987-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21038 CALISTOGA ST.",
            "city": "MIDDLETOWN",
            "state": "CA",
            "postal_code": "954611124",
            "telephone_number": "707-987-2773",
            "fax_number": "707-987-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONOPKA",
        "first_name": "EWA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2015-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "45896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CA

All providers in Middletown, CA · Periodontics in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.