MEDICARE: DR. DAVID A STANCZYK DMD

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	856	WY
2	1223G0001X	General Practice Dentistry	6622	CO

General Provider Information

NPI Number	:	1972598902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A STANCZYK DMD

Provider Business Mailing Address
First Line	:	5389 ABERNATHY CT
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-3275
Country	:	US
Telephone Number	:	703-250-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 AMYS RIDGE EAST CT
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-7103
Country	:	US
Telephone Number	:	937-542-2380
Fax Number	:

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/01/2024

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