Provider Demographics
NPI:1326252206
Name:PILECKI, MARIAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:C
Last Name:PILECKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KRISTON LN
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9527
Mailing Address - Country:US
Mailing Address - Phone:716-625-4131
Mailing Address - Fax:716-625-4431
Practice Address - Street 1:6511 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9210
Practice Address - Country:US
Practice Address - Phone:716-625-4129
Practice Address - Fax:716-625-4491
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY434791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice