Provider Demographics
NPI:1902023807
Name:VAROSCAK, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:VAROSCAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 RTE 17 STE 2007
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2035
Mailing Address - Country:US
Mailing Address - Phone:201-447-9700
Mailing Address - Fax:201-447-4099
Practice Address - Street 1:545 RTE 17 STE 2007
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2035
Practice Address - Country:US
Practice Address - Phone:212-581-4646
Practice Address - Fax:212-757-0224
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300261223P0300X
NJ088671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI00886700OtherLICENSE NUMBER