Provider Demographics
NPI:1790884443
Name:GAWARZEWSKI, RICHARD JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:GAWARZEWSKI
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 1:3 HARKER AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2300
Mailing Address - Country:US
Mailing Address - Phone:856-767-0053
Mailing Address - Fax:756-767-2599
Practice Address - Street 1:3 HARKER AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2300
Practice Address - Country:US
Practice Address - Phone:856-767-0053
Practice Address - Fax:756-767-2599
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014639001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice