Provider Demographics
NPI:1407098817
Name:BEDNARCZYK, JAMES JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:BEDNARCZYK
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 1:65 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2537
Mailing Address - Country:US
Mailing Address - Phone:203-777-8436
Mailing Address - Fax:203-777-8437
Practice Address - Street 1:65 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2537
Practice Address - Country:US
Practice Address - Phone:203-777-8436
Practice Address - Fax:203-777-8437
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist