Provider Demographics
NPI:1790728806
Name:BARCZYNSKI, JOHN L (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:BARCZYNSKI
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 1:710 THOMPSON AVE
Mailing Address - Street 2:STO ROX FAMILY HLTH CTR
Mailing Address - City:MCKEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136
Mailing Address - Country:US
Mailing Address - Phone:412-771-6462
Mailing Address - Fax:412-771-5887
Practice Address - Street 1:710 THOMPSON AVE
Practice Address - Street 2:STO ROX FAMILY HLTH CTR
Practice Address - City:MCKEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136
Practice Address - Country:US
Practice Address - Phone:412-771-6462
Practice Address - Fax:412-771-5887
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022888L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008953110001Medicaid