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General NPI Number Information
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NPI Number | 1992191720
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Entity Type | Organization
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Legal Business Name | JOHN WASNIEWSKI III DMD PA
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 262 FOX HUNT DRIVE
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City | BEAR
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State | DE
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Zip | 19701
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Country | US
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Telephone | 302-832-1371
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Fax | 302-832-9380
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Provider Business Mailing Address
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Address Line | 262 FOX HUNT DRIVE
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City | BEAR
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State | DE
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Zip | 19701
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Country | US
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Telephone | 302-832-1371
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Fax | 302-832-1371
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN J WASNIEWSKI III
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Credential | DMD
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Telephone | 302-832-1371
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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 | G1-0001262
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License Number State | DE
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