Provider Demographics
NPI:1891824140
Name:PAWLOWSKI, PETER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:PAWLOWSKI
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 1:4880 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3903
Mailing Address - Country:US
Mailing Address - Phone:716-683-5840
Mailing Address - Fax:716-683-5841
Practice Address - Street 1:4880 BROADWAY
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3903
Practice Address - Country:US
Practice Address - Phone:716-683-5840
Practice Address - Fax:716-683-5841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0407311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice