Provider Demographics
NPI:1336331693
Name:FOTEK, PAWEL D (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAWEL
Middle Name:D
Last Name:FOTEK
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 1:11641 KEW GARDENS AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2846
Mailing Address - Country:US
Mailing Address - Phone:561-693-3236
Mailing Address - Fax:
Practice Address - Street 1:11641 KEW GARDENS AVE
Practice Address - Street 2:STE 209
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2846
Practice Address - Country:US
Practice Address - Phone:561-693-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN180021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics