Provider Demographics
NPI:1265584650
Name:KWOCHKA, ROBERT KARL (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KARL
Last Name:KWOCHKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FEATHER LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4908
Mailing Address - Country:US
Mailing Address - Phone:203-876-1838
Mailing Address - Fax:203-876-0265
Practice Address - Street 1:239 NAUGATUCK AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-5540
Practice Address - Country:US
Practice Address - Phone:203-876-1838
Practice Address - Fax:203-876-0265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007826OtherCT STATE DENTAL LICENSE