Provider Demographics
NPI:1053487678
Name:CZERNICKI, THOMAS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:CZERNICKI
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 1:3636 MAYFIELD RD
Mailing Address - Street 2:SUITE 100 AMERICAN DENTAL CENTERS
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1403
Mailing Address - Country:US
Mailing Address - Phone:216-291-2600
Mailing Address - Fax:
Practice Address - Street 1:3636 MAYFIELD RD
Practice Address - Street 2:AMERICAN DENTAL CENTERS
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118
Practice Address - Country:US
Practice Address - Phone:216-291-2600
Practice Address - Fax:216-291-2602
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300173231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice