Provider Demographics
NPI:1215249313
Name:PELKA, JAKUB (DMD)
Entity type:Individual
Prefix:
First Name:JAKUB
Middle Name:
Last Name:PELKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 REGENT CT
Mailing Address - Street 2:STE. 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7966
Mailing Address - Country:US
Mailing Address - Phone:814-234-2428
Mailing Address - Fax:814-231-0118
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:STE. 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7966
Practice Address - Country:US
Practice Address - Phone:814-234-2428
Practice Address - Fax:814-231-0118
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics