Provider Demographics
NPI:1982777363
Name:CZUBKOWSKI, GARY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:CZUBKOWSKI
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 1:8637 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3745
Mailing Address - Country:US
Mailing Address - Phone:414-462-3140
Mailing Address - Fax:
Practice Address - Street 1:8637 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3745
Practice Address - Country:US
Practice Address - Phone:414-462-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2759-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist