Provider Demographics
NPI:1225182611
Name:CHARNITSKI, JAN CLEMENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:CLEMENT
Last Name:CHARNITSKI
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 1:1830 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1945
Mailing Address - Country:US
Mailing Address - Phone:570-343-4472
Mailing Address - Fax:
Practice Address - Street 1:1830 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1945
Practice Address - Country:US
Practice Address - Phone:570-343-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018018-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice