Provider Demographics
NPI:1295156081
Name:TAKACS, JOHN ALEX (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEX
Last Name:TAKACS
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 1:710 STOKES AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3117
Mailing Address - Country:US
Mailing Address - Phone:215-287-9871
Mailing Address - Fax:
Practice Address - Street 1:2114 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2427
Practice Address - Country:US
Practice Address - Phone:215-287-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist