MEDICARE: DR. THADDEUS G. ZAWISLAK JR. D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS026933L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063499986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THADDEUS G. ZAWISLAK JR. D.M.D.

Provider Business Mailing Address
First Line	:	161 E BISSELL AVE
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-1972
Country	:	US
Telephone Number	:	814-677-1341
Fax Number	:	814-676-6627

Provider Business Practice Location Address
First Line	:	161 E BISSELL AVE
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-1972
Country	:	US
Telephone Number	:	814-677-1341
Fax Number	:	814-676-6627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	08/11/2014

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