Healthcare Provider Details

I. General information

NPI: 1245240399
Provider Name (Legal Business Name): MICHAEL J STRONCZEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 CARNEGIE BLVD
FORT WAYNE IN
46804-5792
US

IV. Provider business mailing address

4606 D EAST STATE BLVD
FORT WAYNE IN
46815-6963
US

V. Phone/Fax

Practice location:
  • Phone: 260-423-2340
  • Fax:
Mailing address:
  • Phone: 260-423-2340
  • Fax: 260-422-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009084
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12009084
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: