Provider Demographics
NPI:1154450047
Name:DWORAK, MAREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAREK
Middle Name:
Last Name:DWORAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1732
Mailing Address - Country:US
Mailing Address - Phone:856-582-1000
Mailing Address - Fax:856-589-1093
Practice Address - Street 1:474 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:ATRIUM 1 SUITE A
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2321
Practice Address - Country:US
Practice Address - Phone:856-582-1000
Practice Address - Fax:856-589-1093
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI23083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist