Healthcare Provider Details

I. General information

NPI: 1255301578
Provider Name (Legal Business Name): GREGORY ALAN WASKEWICZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CENTER 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

19204 HONEYSTONE PL
BROOKEVILLE MD
20833-3211
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4340
  • Fax:
Mailing address:
  • Phone: 301-570-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number34438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: