Provider Demographics
NPI:1528295920
Name:JAZWIECKI, THOMAS R (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:JAZWIECKI
Suffix:
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 1:8241 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8346
Mailing Address - Country:US
Mailing Address - Phone:414-939-1024
Mailing Address - Fax:414-762-5974
Practice Address - Street 1:8241 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8346
Practice Address - Country:US
Practice Address - Phone:414-939-1024
Practice Address - Fax:414-762-5974
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6413-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist