Provider Demographics
NPI:1710329982
Name:BEREZNAK, CHIRSTOPHER G (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHIRSTOPHER
Middle Name:G
Last Name:BEREZNAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 SR 6
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7906
Mailing Address - Country:US
Mailing Address - Phone:570-836-2808
Mailing Address - Fax:570-836-6180
Practice Address - Street 1:6052 SR 6
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7906
Practice Address - Country:US
Practice Address - Phone:570-836-2808
Practice Address - Fax:570-836-6180
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029539L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice