Provider Demographics
NPI:1962882308
Name:ADAMCZYK, THERESA (DDS)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ADAMCZYK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 W GRANDE MARKET DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8442
Mailing Address - Country:US
Mailing Address - Phone:920-731-7445
Mailing Address - Fax:920-882-2946
Practice Address - Street 1:550 CITY CTR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4830
Practice Address - Country:US
Practice Address - Phone:920-731-7445
Practice Address - Fax:920-651-3485
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001079-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice