Provider Demographics
NPI:1366653909
Name:STEPHEN F GAZDICK DDS PC
Entity Type:Organization
Organization Name:STEPHEN F GAZDICK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOZDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-855-1438
Mailing Address - Street 1:461 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2511
Mailing Address - Country:US
Mailing Address - Phone:215-855-1438
Mailing Address - Fax:
Practice Address - Street 1:461 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2511
Practice Address - Country:US
Practice Address - Phone:215-855-1438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017663L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty