Provider Demographics
NPI:1972598902
Name:STANCZYK, DAVID A (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:STANCZYK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5389 ABERNATHY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3275
Mailing Address - Country:US
Mailing Address - Phone:703-250-1365
Mailing Address - Fax:
Practice Address - Street 1:2040 AMYS RIDGE EAST CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-7103
Practice Address - Country:US
Practice Address - Phone:937-542-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8561223G0001X
CO66221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice