Provider Demographics
NPI:1174620140
Name:SZAFAREK, BERNICE (DMD)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:SZAFAREK
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:PO BOX 87
Mailing Address - Street 2:187 RT 66E
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237
Mailing Address - Country:US
Mailing Address - Phone:860-228-8492
Mailing Address - Fax:860-228-8495
Practice Address - Street 1:187 ROUTE 66E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237
Practice Address - Country:US
Practice Address - Phone:860-228-8492
Practice Address - Fax:860-228-8495
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice