Provider Demographics
NPI:1295317683
Name:ADAMCZYK, MARLENA JOANNA
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:JOANNA
Last Name:ADAMCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 HIGHGROVE WAY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1993
Mailing Address - Country:US
Mailing Address - Phone:404-452-2326
Mailing Address - Fax:
Practice Address - Street 1:32 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4421
Practice Address - Country:US
Practice Address - Phone:718-624-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0634071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry