Provider Demographics
NPI:1881152684
Name:SZANDZIK, DAVID LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:SZANDZIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0531
Mailing Address - Country:US
Mailing Address - Phone:409-772-1546
Mailing Address - Fax:409-747-7378
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0531
Practice Address - Country:US
Practice Address - Phone:409-772-1546
Practice Address - Fax:409-747-7378
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901022672OtherDENTAL LICENSE
5315093446OtherCONTROLLED SUBSTANCE LICENSE