Provider Demographics
NPI:1629390273
Name:K. PETE CZARUK, D.D.S., INC.
Entity Type:Organization
Organization Name:K. PETE CZARUK, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSITANT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CODA, CP
Authorized Official - Phone:614-459-3740
Mailing Address - Street 1:2066 W HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2452
Mailing Address - Country:US
Mailing Address - Phone:614-459-3740
Mailing Address - Fax:614-586-0065
Practice Address - Street 1:2066 W HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2452
Practice Address - Country:US
Practice Address - Phone:614-459-3740
Practice Address - Fax:614-586-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0368785Medicaid