Provider Demographics
NPI:1013272160
Name:JANIK, JUSTIN V (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:V
Last Name:JANIK
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 1:407 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORISKANY
Mailing Address - State:NY
Mailing Address - Zip Code:13424-5049
Mailing Address - Country:US
Mailing Address - Phone:315-269-7907
Mailing Address - Fax:
Practice Address - Street 1:576 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-2434
Practice Address - Country:US
Practice Address - Phone:315-269-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0566991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice