Provider Demographics
NPI:1952446437
Name:CZARNOWSKA, AGATA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:AGATA
Middle Name:
Last Name:CZARNOWSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057
Mailing Address - Country:US
Mailing Address - Phone:973-594-8885
Mailing Address - Fax:973-594-8840
Practice Address - Street 1:27 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057
Practice Address - Country:US
Practice Address - Phone:973-594-8885
Practice Address - Fax:973-594-8840
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02244200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist