Healthcare Provider Details

I. General information

NPI: 1578751848
Provider Name (Legal Business Name): VICTOR PAUL SZAREJKO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 EAST AVE
YOUNGSTOWN NY
14174-1321
US

IV. Provider business mailing address

3344 EAST AVE
YOUNGSTOWN NY
14174-1321
US

V. Phone/Fax

Practice location:
  • Phone: 716-745-3673
  • Fax:
Mailing address:
  • Phone: 716-745-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number027329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: