Provider Demographics
NPI:1497933071
Name:TANCHYK, AMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:TANCHYK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:ROOM B-854 DEPT OF OMFS
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-5026
Mailing Address - Fax:973-972-3070
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:ROOM C-401 UNIT ONE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-5026
Practice Address - Fax:973-972-3070
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI023503001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery