Provider Demographics
NPI:1982728788
Name:OWCZARZAK, TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:OWCZARZAK
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:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:315-454-8650
Practice Address - Street 1:7273 B MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:PA
Practice Address - Zip Code:15327
Practice Address - Country:US
Practice Address - Phone:412-364-6440
Practice Address - Fax:412-364-9504
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027955L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist