Provider Demographics
NPI:1578568937
Name:JACHIMOWICZ, STANLEY C (DDS)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:C
Last Name:JACHIMOWICZ
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 1:13590B N MERIDIAN ST
Mailing Address - Street 2:STE 105
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1409
Mailing Address - Country:US
Mailing Address - Phone:317-844-7626
Mailing Address - Fax:317-844-3804
Practice Address - Street 1:13590B N MERIDIAN ST
Practice Address - Street 2:STE 105
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1409
Practice Address - Country:US
Practice Address - Phone:317-844-7626
Practice Address - Fax:317-844-3804
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
IN12009721A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU92189Medicare UPIN
IN217420Medicare ID - Type UnspecifiedPROVIDER NUMBER