Provider Demographics
NPI:1700993466
Name:STRYCHALSKI, IRENE D (DDS MS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:D
Last Name:STRYCHALSKI
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048
Mailing Address - Country:US
Mailing Address - Phone:716-366-0600
Mailing Address - Fax:716-366-3077
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048
Practice Address - Country:US
Practice Address - Phone:716-366-0600
Practice Address - Fax:716-366-3077
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00613438Medicaid