Provider Demographics
NPI:1316199235
Name:MIELCAREK, JASON T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:MIELCAREK
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 1:291 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1925
Mailing Address - Country:US
Mailing Address - Phone:860-677-8666
Mailing Address - Fax:860-677-5839
Practice Address - Street 1:291 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1925
Practice Address - Country:US
Practice Address - Phone:860-677-8666
Practice Address - Fax:860-677-5839
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist