Provider Demographics
NPI:1245377225
Name:EGNACZYK, R. GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:GREGORY
Last Name:EGNACZYK
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 1:534 SHELTON AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2804
Mailing Address - Country:US
Mailing Address - Phone:203-929-6338
Mailing Address - Fax:203-929-7619
Practice Address - Street 1:534 SHELTON AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2804
Practice Address - Country:US
Practice Address - Phone:203-929-6338
Practice Address - Fax:203-929-7619
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice