Provider Demographics
NPI:1164680989
Name:MARCINCZYK, ELZBIETA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELZBIETA
Middle Name:
Last Name:MARCINCZYK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2259
Mailing Address - Country:US
Mailing Address - Phone:860-922-1067
Mailing Address - Fax:
Practice Address - Street 1:270 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2315
Practice Address - Country:US
Practice Address - Phone:860-289-9558
Practice Address - Fax:860-289-9054
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid