# NICHOLAS J FEDORKA DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265571426
- **Authorized official:** DR. NICHOLAS JEROME FEDORKA DMD (OWNER ORAL & MAXILLOFACIAL SURGEON)
- **Authorized official phone:** (814) 336-3357

## Contact information

- **Practice address:** 505 POPLAR STREET, MEADVILLE, PA 16335
- **Practice address phone:** (814) 333-4454
- **Practice address fax:** (814) 336-3357
- **Mailing address:** 505 POPLAR STREET, MEADVILLE, PA 16335
- **Mailing address phone:** (814) 333-4454
- **Mailing address fax:** (814) 336-3357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | DS023205L | PA | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 10/02/2007