Provider Demographics
NPI:1790906592
Name:GARCZYNSKI, DOUGLAS CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:GARCZYNSKI
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 1:16814 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5216
Mailing Address - Country:US
Mailing Address - Phone:718-658-0123
Mailing Address - Fax:718-658-1211
Practice Address - Street 1:16814 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5216
Practice Address - Country:US
Practice Address - Phone:718-658-0123
Practice Address - Fax:718-658-1211
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01001225Medicaid