Healthcare Provider Details

I. General information

NPI: 1659072270
Provider Name (Legal Business Name): MARIA JANE CZYZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 10/23/2023
Certification Date: 03/10/2023
Deactivation Date: 10/12/2023
Reactivation Date: 10/23/2023

III. Provider practice location address

4915 25TH AVE SUITE 205
SEATTLE WA
98105
US

IV. Provider business mailing address

4915 25TH AVE NE SUITE 205
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-1600
  • Fax: 206-524-1603
Mailing address:
  • Phone: 206-524-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDR61425852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: