Provider Demographics
NPI:1679659957
Name:GORZELNIK, ROBERT M (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GORZELNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 CATAMARAN CT
Mailing Address - Street 2:
Mailing Address - City:MT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1433
Mailing Address - Country:US
Mailing Address - Phone:973-601-7618
Mailing Address - Fax:
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:STE. 101
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2174
Practice Address - Country:US
Practice Address - Phone:973-627-6006
Practice Address - Fax:973-627-4337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ76211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069841Medicare UPIN