Healthcare Provider Details

I. General information

NPI: 1215996871
Provider Name (Legal Business Name): DOLORES J. WAWRZYNEK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 PAYNE AVE
N TONAWANDA NY
14120-6903
US

IV. Provider business mailing address

475 PAYNE AVE
N TONAWANDA NY
14120-6903
US

V. Phone/Fax

Practice location:
  • Phone: 716-695-4984
  • Fax: 716-695-4985
Mailing address:
  • Phone: 716-695-4984
  • Fax: 716-695-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number039532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: