Provider Demographics
NPI:1528156643
Name:CIESLIK, EWA AGATA (DMD)
Entity type:Individual
Prefix:DR
First Name:EWA
Middle Name:AGATA
Last Name:CIESLIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PLEASANT ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5786
Mailing Address - Country:US
Mailing Address - Phone:203-237-6400
Mailing Address - Fax:203-237-9769
Practice Address - Street 1:35 PLEASANT ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5786
Practice Address - Country:US
Practice Address - Phone:203-237-6400
Practice Address - Fax:203-237-9769
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8908122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice