Provider Demographics
NPI:1881696938
Name:ZIEMSKI, JACEK T (DDS)
Entity type:Individual
Prefix:DR
First Name:JACEK
Middle Name:T
Last Name:ZIEMSKI
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 1:165 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4008
Mailing Address - Country:US
Mailing Address - Phone:203-516-2006
Mailing Address - Fax:
Practice Address - Street 1:165 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4008
Practice Address - Country:US
Practice Address - Phone:203-516-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9068122300000X, 1223G0001X
NY49611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist