Provider Demographics
NPI:1639413214
Name:ZAWADOWYCZ, DIANA E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:ZAWADOWYCZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LAWRENCEVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3551
Mailing Address - Country:US
Mailing Address - Phone:609-883-1770
Mailing Address - Fax:609-883-1777
Practice Address - Street 1:1200 LAWRENCEVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3551
Practice Address - Country:US
Practice Address - Phone:609-883-1770
Practice Address - Fax:609-883-1777
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01797300122300000X
PADS027703L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist