Provider Demographics
NPI:1588733687
Name:HETZER AND JANCZAKOWSKI, DDS, PLLC
Entity type:Organization
Organization Name:HETZER AND JANCZAKOWSKI, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HETZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-771-9090
Mailing Address - Street 1:18905 33RD AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4730
Mailing Address - Country:US
Mailing Address - Phone:425-771-9090
Mailing Address - Fax:425-775-1549
Practice Address - Street 1:18905 33RD AVE W STE 201
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4730
Practice Address - Country:US
Practice Address - Phone:425-771-9090
Practice Address - Fax:425-775-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA78801223G0001X
WA70511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty