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General NPI Number Information
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NPI Number | 1649375973
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Entity Type | Organization
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Legal Business Name | DANIEL J WADZINSKI DDS SC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 EAST VERONA AVENUE
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City | VERONA
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State | WI
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Zip | 53593
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Country | US
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Telephone | 608-854-6612
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Fax | 608-845-8131
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Provider Business Mailing Address
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Address Line | 109 EAST VERONA AVENUE
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City | VERONA
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State | WI
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Zip | 53593
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Country | US
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Telephone | 608-854-6612
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Fax | 608-845-8131
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Authorized Official
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Title or Position | DR PRESIDENT OWNER
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Name | DANIEL JOSEPH WADZINSKI
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Credential | DDS
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Telephone | 608-845-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3838015
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License Number State | WI
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