Provider Demographics
NPI:1164864823
Name:BRIAN K. SAWCHUK, D.D.S. AND DAVID J. SLIVA, D.M.D., L.L. C.
Entity type:Organization
Organization Name:BRIAN K. SAWCHUK, D.D.S. AND DAVID J. SLIVA, D.M.D., L.L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFNACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-669-4966
Mailing Address - Street 1:8 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2058
Mailing Address - Country:US
Mailing Address - Phone:860-669-4966
Mailing Address - Fax:
Practice Address - Street 1:8 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2058
Practice Address - Country:US
Practice Address - Phone:860-669-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5226 61381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty