Provider Demographics
NPI:1457523896
Name:KACZAJ, MARTA A (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:A
Last Name:KACZAJ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2707
Mailing Address - Country:US
Mailing Address - Phone:215-885-7337
Mailing Address - Fax:267-627-2361
Practice Address - Street 1:609 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2707
Practice Address - Country:US
Practice Address - Phone:215-885-7337
Practice Address - Fax:267-627-2361
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026097L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist