Healthcare Provider Details

I. General information

NPI: 1790070209
Provider Name (Legal Business Name): WANDA J. JANIK D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 HAUSMAN RD
ALLENTOWN PA
18104-9258
US

IV. Provider business mailing address

1525 HAUSMAN RD
ALLENTOWN PA
18104-9258
US

V. Phone/Fax

Practice location:
  • Phone: 610-433-5111
  • Fax: 610-433-4393
Mailing address:
  • Phone: 610-433-5111
  • Fax: 610-433-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS027471L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: