Provider Demographics
NPI:1184738759
Name:SACZAWA, ALAN F (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:F
Last Name:SACZAWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1252
Mailing Address - Country:US
Mailing Address - Phone:973-235-0336
Mailing Address - Fax:
Practice Address - Street 1:591 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1252
Practice Address - Country:US
Practice Address - Phone:973-235-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9966OtherDELTA DENTAL OF NJ