Provider Demographics
NPI:1790849834
Name:CZEBRINSKI, EDWARD STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEVEN
Last Name:CZEBRINSKI
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 1:77 WESTPORT PLAZA MEDICAL CENTER
Mailing Address - Street 2:SUITE 356
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-878-1401
Mailing Address - Fax:
Practice Address - Street 1:77 WESTPORT PLAZA MEDICAL CENTER
Practice Address - Street 2:SUITE 356
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-878-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO GEN #011763204E00000X
MOMO SPEC #00483204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81080Medicare UPIN