Provider Demographics
NPI:1427080506
Name:JAWORSKI, STEPHEN (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:JAWORSKI
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 1:620 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1145
Mailing Address - Country:US
Mailing Address - Phone:814-275-4220
Mailing Address - Fax:814-275-1236
Practice Address - Street 1:620 WOOD ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1145
Practice Address - Country:US
Practice Address - Phone:814-275-4220
Practice Address - Fax:814-275-1236
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020856L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice