Provider Demographics
NPI:1720174923
Name:PAWLECKI, JAMES (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PAWLECKI
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 1:133 W HULL DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3703
Mailing Address - Country:US
Mailing Address - Phone:740-363-3871
Mailing Address - Fax:740-369-6616
Practice Address - Street 1:133 W HULL DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3703
Practice Address - Country:US
Practice Address - Phone:740-363-3871
Practice Address - Fax:740-369-6616
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106371223G0001X
OH0223791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5052733Medicaid
911019392OtherCOMMERCIAL
WA5052733OtherCHPW
WA215835OtherL & I