Provider Demographics
NPI:1891914750
Name:CIECHANOWSKI, TERESA W (DMD08)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:W
Last Name:CIECHANOWSKI
Suffix:
Gender:F
Credentials:DMD08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1329
Mailing Address - Country:US
Mailing Address - Phone:860-229-0622
Mailing Address - Fax:860-229-2836
Practice Address - Street 1:393 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1329
Practice Address - Country:US
Practice Address - Phone:860-229-0622
Practice Address - Fax:860-229-2836
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice