MEDICARE: MR. STAN CZERWINSKI CMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122400000X	Denturist	17841	CA

General Provider Information

NPI Number	:	1063738482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STAN CZERWINSKI CMD

Provider Business Mailing Address
First Line	:	400 MOBIL AVE
Second Line	:	SUITE A3
City	:	CAMARILLO
State	:	CA
Zip	:	93010-6338
Country	:	US
Telephone Number	:	805-987-0632
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 MOBIL AVE
Second Line	:	SUITE A3
City	:	CAMARILLO
State	:	CA
Zip	:	93010-6338
Country	:	US
Telephone Number	:	805-987-0632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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