Provider Demographics
NPI:1770675951
Name:JUOZOKAS, EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:JUOZOKAS
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 1:115 ELM ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3712
Mailing Address - Country:US
Mailing Address - Phone:860-741-2277
Mailing Address - Fax:860-253-0170
Practice Address - Street 1:115 ELM ST
Practice Address - Street 2:SUITE 209
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3712
Practice Address - Country:US
Practice Address - Phone:860-741-2277
Practice Address - Fax:860-253-0170
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT190000552Medicare ID - Type Unspecified