Provider Demographics
NPI:1649437005
Name:FAMILY DENTAL STUDIO P.C.
Entity type:Organization
Organization Name:FAMILY DENTAL STUDIO P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DYCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-389-8200
Mailing Address - Street 1:147 DRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4213
Mailing Address - Country:US
Mailing Address - Phone:718-389-8200
Mailing Address - Fax:
Practice Address - Street 1:147 DRIGGS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4213
Practice Address - Country:US
Practice Address - Phone:718-389-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046439-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental