Organization
JOSEPH L KACZOR, INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH KACZOR DMD (PRESIDENT)
(814) 944-6355
Entity
Organization
Contact information
Practice address
2606 BROAD AVE., ALTOONA, PA 16601-1915
(814) 944-6355
(814) 941-7324
Mailing address
2606 BROAD AVE., ALTOONA, PA 16601-1915
(814) 944-6355
(814) 941-7324
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS022361-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000060334
HIGHMARK BC/BS
PA
05
—
0019426300002
—
PA
Enumeration date
10/19/2006
Last updated
06/18/2009
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