Provider Demographics
NPI:1437176864
Name:CHOROSZEWSKI, JEFFREY S (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:CHOROSZEWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:S
Other - Last Name:CHOROSZEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PA
Mailing Address - Street 1:5248 CEDAR LAKE
Mailing Address - Street 2:APT 151
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:412-889-5130
Mailing Address - Fax:
Practice Address - Street 1:10318A BALTIMORE NATIONAL PARK
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-418-4475
Practice Address - Fax:410-418-4424
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist