Provider Demographics
NPI:1376607416
Name:EDWARD S CZEBRINSKI DMD PC
Entity Type:Organization
Organization Name:EDWARD S CZEBRINSKI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CZEBRINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-878-1401
Mailing Address - Street 1:77 WESTPORT PLAZA MEDICAL CENTER
Mailing Address - Street 2:SUITE 356
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-878-1401
Mailing Address - Fax:
Practice Address - Street 1:77 WESTPORT PLAZA MEDICAL CENTER
Practice Address - Street 2:SUITE 356
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-878-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO GEN #011763204E00000X
MOMO SPEC #00483204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81080Medicare UPIN