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General NPI Number Information
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NPI Number | 1265632715
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Entity Type | Individual
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Provider Name | JOHN PHILLIP WASCHAK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 560 NE E ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-2326
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Country | US
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Telephone | 541-476-8383
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Fax | 541-470-0751
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Provider Business Mailing Address
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Address Line | 560 NE E ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-2326
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Country | US
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Telephone | 541-476-8383
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Fax | 541-470-0751
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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 | D9097
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 55033
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 55033
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D9097
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License Number State | OR
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