Healthcare Provider Details

I. General information

NPI: 1295830529
Provider Name (Legal Business Name): DANIEL JOSEPH WADZINSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EAST VERONA AVENUE
VERONA WI
53593
US

IV. Provider business mailing address

613 GRACE STREET
VERONA WI
53593
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-6612
  • Fax: 608-845-8131
Mailing address:
  • Phone: 608-845-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3838015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: