MEDICARE: DR. PAUL J NAWIESNIAK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-020493	IL
2	1223G0001X	General Practice Dentistry	9800	TN

General Provider Information

NPI Number	:	1891800587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J NAWIESNIAK DDS

Provider Business Mailing Address
First Line	:	8910 BRADFORD WAY
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-5861
Country	:	US
Telephone Number	:	301-694-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE SW
Second Line	:	579 MDG
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:	703-681-7127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/31/2014

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