Provider Demographics
NPI:1073720264
Name:PIELAK, DAVID CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:PIELAK
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 1:1641 DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4231
Mailing Address - Country:US
Mailing Address - Phone:727-789-1980
Mailing Address - Fax:727-789-4686
Practice Address - Street 1:1641 DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4231
Practice Address - Country:US
Practice Address - Phone:727-789-1980
Practice Address - Fax:727-789-4686
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist