Provider Demographics
NPI:1780696450
Name:CZONSTKOWSKY, MARIO (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:CZONSTKOWSKY
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S CRAIG ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3709
Mailing Address - Country:US
Mailing Address - Phone:412-681-2991
Mailing Address - Fax:412-681-2664
Practice Address - Street 1:410 S CRAIG ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3709
Practice Address - Country:US
Practice Address - Phone:412-681-2991
Practice Address - Fax:412-681-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO26059-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADSO26059-LOtherENDODONTICS