Provider Demographics
NPI:1073174520
Name:MACIEJESKI, ROXANA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:L
Last Name:MACIEJESKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROXANA
Other - Middle Name:L
Other - Last Name:CIOBOTARU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:350 THUNDER CIR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2164
Mailing Address - Country:US
Mailing Address - Phone:702-600-3964
Mailing Address - Fax:
Practice Address - Street 1:5597 TULIP ST STE B4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1562
Practice Address - Country:US
Practice Address - Phone:702-600-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0042376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist