Provider Demographics
NPI:1932120417
Name:JANZARUK, RICHARD VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VINCENT
Last Name:JANZARUK
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:PO BOX 2708
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46018-2708
Mailing Address - Country:US
Mailing Address - Phone:765-649-5257
Mailing Address - Fax:765-649-1544
Practice Address - Street 1:3225 NICHOL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3148
Practice Address - Country:US
Practice Address - Phone:765-649-5257
Practice Address - Fax:765-649-1544
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice