Healthcare Provider Details

I. General information

NPI: 1881696938
Provider Name (Legal Business Name): JACEK T ZIEMSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 HUNTINGTON RD
STRATFORD CT
06614-4008
US

IV. Provider business mailing address

165 HUNTINGTON RD
STRATFORD CT
06614-4008
US

V. Phone/Fax

Practice location:
  • Phone: 203-516-2006
  • Fax:
Mailing address:
  • Phone: 203-516-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9068
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number49611
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9068
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: