Provider Demographics
NPI:1447263199
Name:PAWELEK, CHRISTOPHER TADEUSZ (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TADEUSZ
Last Name:PAWELEK
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 1:6318 KILLOE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9080
Mailing Address - Country:US
Mailing Address - Phone:315-720-1092
Mailing Address - Fax:315-699-4560
Practice Address - Street 1:6100 ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-699-2685
Practice Address - Fax:315-699-4560
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0475721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice