Provider Demographics
NPI:1154879344
Name:PDSC PC
Entity type:Organization
Organization Name:PDSC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OW
Authorized Official - Prefix:DR
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BIELECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-924-8535
Mailing Address - Street 1:2603 VINEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3370
Mailing Address - Country:US
Mailing Address - Phone:719-924-8535
Mailing Address - Fax:
Practice Address - Street 1:2041 PEPPER LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3276
Practice Address - Country:US
Practice Address - Phone:719-564-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8809OtherSTATE OF COLORADO BOARD OF EXAMINERS