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General NPI Number Information
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NPI Number | 1255426813
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Entity Type | Individual
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Provider Name | KATHRYN RAND WACKER DDS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 4306 SENECA STREET
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City | WEST SENECA
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State | NY
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Zip | 14224
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Country | US
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Telephone | 716-675-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 505 CORTONO DR
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City | RENO
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State | NV
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Zip | 89521-4292
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Country | US
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Telephone | 716-445-3341
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 047723
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-349C
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License Number State | NV
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