Provider Demographics
NPI:1700339397
Name:CHAPOKAS LUCZYNSKI DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:CHAPOKAS LUCZYNSKI DENTAL PARTNERSHIP
Other - Org Name:C & L DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CHAPOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:619-297-2949
Mailing Address - Street 1:3730 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4112
Mailing Address - Country:US
Mailing Address - Phone:619-297-2949
Mailing Address - Fax:619-297-8535
Practice Address - Street 1:3730 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4112
Practice Address - Country:US
Practice Address - Phone:619-297-2949
Practice Address - Fax:619-297-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29814122300000X
CA59349122300000X
CA588901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty