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General NPI Number Information
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NPI Number | 1720521669
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Entity Type | Organization
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Legal Business Name | WIERNICKI & SENYSHYN P.A.
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Dates
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Enumeration Date | 11/27/2016
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Last Update Date | 03/19/2017
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Provider Practice Location Address
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Address Line | 190 NW SPANISH RIVER BLVD SUITE #100
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City | BOCA RATON
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State | FL
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Zip | 33431-4217
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Country | US
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Telephone | 561-392-4010
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Fax | 561-392-4012
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Provider Business Mailing Address
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Address Line | 190 NW SPANISH RIVER BLVD SUITE #100
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City | BOCA RATON
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State | FL
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Zip | 33431-4217
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Country | US
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Telephone | 561-392-4010
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Fax | 561-392-4012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS R. WIERNICKI
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Credential | DMD
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Telephone | 561-392-4010
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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 | DN12092
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License Number State | FL
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