Provider Demographics
NPI:1053369462
Name:TOMCZYK, CHRISTOPHER A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:TOMCZYK
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 1:220 W COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1252
Mailing Address - Country:US
Mailing Address - Phone:269-945-5656
Mailing Address - Fax:269-945-0396
Practice Address - Street 1:220 W COLFAX ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1252
Practice Address - Country:US
Practice Address - Phone:269-945-5656
Practice Address - Fax:269-945-0396
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010156881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID156880OtherBC/BS OF MICHIGAN
MI4819461Medicaid