Provider Demographics
NPI:1396860912
Name:PYTLIK, RAFAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAL
Middle Name:
Last Name:PYTLIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W MESCAL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4764
Mailing Address - Country:US
Mailing Address - Phone:602-944-0073
Mailing Address - Fax:602-944-0371
Practice Address - Street 1:13360 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4837
Practice Address - Country:US
Practice Address - Phone:623-977-2551
Practice Address - Fax:623-298-5692
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist