Organization
NICHOLAS J FEDORKA DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS JEROME FEDORKA DMD (OWNER ORAL & MAXILLOFACIAL SURGEON)
(814) 336-3357
Entity
Organization
Contact information
Practice address
505 POPLAR STREET, MEADVILLE, PA 16335
(814) 333-4454
(814) 336-3357
Mailing address
505 POPLAR STREET, MEADVILLE, PA 16335
(814) 333-4454
(814) 336-3357
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
DS023205L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008854040002
—
PA
05
—
0008854040004
—
PA
01
—
103082
UPMC
—
01
—
134372
HIGHMARK BCBS
—
Enumeration date
02/05/2007
Last updated
10/02/2007
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