1437342151 NPI number — DR. STEFAN A PLOSZAK DDS

Table of content: DR. STEFAN A PLOSZAK DDS (NPI 1437342151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437342151 NPI number — DR. STEFAN A PLOSZAK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOSZAK
Provider First Name:
STEFAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437342151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 SOUTH BLVD
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28217-4458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-247-0400
Provider Business Mailing Address Fax Number:
704-556-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 SOUTH BLVD
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-4458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-247-0400
Provider Business Practice Location Address Fax Number:
704-556-5950
Provider Enumeration Date:
08/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8395 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5907948 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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