MEDICARE: LARRY A WOZNUK DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1801341847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY A WOZNUK DDS INC

Provider Business Mailing Address
First Line	:	3625 MIDWAY DR
Second Line	:	STE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	619-224-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 MIDWAY DR
Second Line	:	STE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	619-224-2204
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY WOZNUK
Credential	:	DDS
Telephone Number	:	619-224-2204

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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