MEDICARE: DR. JACEK T ZIEMSKI DDS

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	122300000X	Dentist	9068	CT
2	122300000X	Dentist	49611	NY
3	1223G0001X	General Practice Dentistry	9068	CT

General Provider Information

NPI Number	:	1881696938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACEK T ZIEMSKI DDS

Provider Business Mailing Address
First Line	:	165 HUNTINGTON RD
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-4008
Country	:	US
Telephone Number	:	203-516-2006
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 HUNTINGTON RD
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-4008
Country	:	US
Telephone Number	:	203-516-2006
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/25/2013

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