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General NPI Number Information
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NPI Number | 1629390273
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Entity Type | Organization
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Legal Business Name | K. PETE CZARUK, D.D.S., INC.
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 2066 W HENDERSON RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2452
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Country | US
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Telephone | 614-459-3740
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Fax | 614-586-0065
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Provider Business Mailing Address
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Address Line | 2066 W HENDERSON RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2452
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Country | US
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Telephone | 614-459-3740
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Fax | 614-586-0065
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Authorized Official
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Title or Position | DENTAL ASSITANT
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Name | PAMELLA COLLINS
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Credential | CODA, CP
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Telephone | 614-459-3740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30015642
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License Number State | OH
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