Provider Demographics
NPI:1750596722
Name:GIEMZA, RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GIEMZA
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 1:225 STATE ROUTE 10 E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1300
Mailing Address - Country:US
Mailing Address - Phone:973-584-5221
Mailing Address - Fax:973-584-8774
Practice Address - Street 1:225 STATE ROUTE 10 E
Practice Address - Street 2:SUITE 203
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1300
Practice Address - Country:US
Practice Address - Phone:973-584-5221
Practice Address - Fax:973-584-8774
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ109601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice