Provider Demographics
NPI:1316087158
Name:SROCZYNSKI, CLARENCE FRANK JR (DDS)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:FRANK
Last Name:SROCZYNSKI
Suffix:JR
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 1:34441 EIGHT MILE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:248-474-7122
Mailing Address - Fax:
Practice Address - Street 1:34441 EIGHT MILE
Practice Address - Street 2:SUITE 106
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-474-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist