Provider Demographics
NPI:1902432479
Name:PAWEL R BIELECKI, DDS, PC
Entity Type:Organization
Organization Name:PAWEL R BIELECKI, DDS, PC
Other - Org Name:YOUNG AT HEART DENTISTRY LA JUNTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-696-9009
Mailing Address - Street 1:2041 PEPPER LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3276
Mailing Address - Country:US
Mailing Address - Phone:719-696-9009
Mailing Address - Fax:
Practice Address - Street 1:317 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-733-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental