Provider Demographics
NPI:1033298419
Name:KRYZANIWSKY, GEORGE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:KRYZANIWSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2366
Mailing Address - Country:US
Mailing Address - Phone:973-377-7234
Mailing Address - Fax:973-377-7044
Practice Address - Street 1:6 INDEPENDENCE CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2366
Practice Address - Country:US
Practice Address - Phone:973-377-7234
Practice Address - Fax:973-377-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1017539001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22D101753900OtherD.D.S. LICENSE