Provider Demographics
NPI:1194187005
Name:EDWIN JOHN SZCZEPANIK
Entity Type:Organization
Organization Name:EDWIN JOHN SZCZEPANIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SZCZEPANIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-352-6888
Mailing Address - Street 1:7758 WALLACE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7217
Mailing Address - Country:US
Mailing Address - Phone:407-352-6888
Mailing Address - Fax:407-352-0560
Practice Address - Street 1:7758 WALLACE RD STE 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7217
Practice Address - Country:US
Practice Address - Phone:407-352-6888
Practice Address - Fax:407-352-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8437122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty