Healthcare Provider Details

I. General information

NPI: 1609821347
Provider Name (Legal Business Name): JANET ANN GOLASZEWSKI DMD M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. JANET ANN MAZZOCCO

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S CHURCH ST STE 190 SOUTH GATE OFFICE COMPLEX
HAZLETON PA
18201-7605
US

IV. Provider business mailing address

305 S CHURCH ST STE 190 SOUTH GATE OFFICE COMPLEX
HAZLETON PA
18201-7605
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-8601
  • Fax: 570-455-8369
Mailing address:
  • Phone: 570-454-8601
  • Fax: 570-455-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS019709L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: