Individual
DR. JONATHAN LESLIE CZEREPAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2716 RIELLY ROAD, FORT, NC 28310-7302
(910) 643-2196
(910) 396-7017
Mailing address
226 BAINBRIDGE DR, EVANS, GA 30809-7302
(603) 491-2050
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1856104
MA
1223G0001X
General Practice Dentistry
DN1856104
MA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN1856104
MA
Other
Enumeration date
08/27/2012
Last updated
08/22/2017
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