Provider Demographics
NPI:1073614947
Name:WOLANIN, CASIMIR M (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASIMIR
Middle Name:M
Last Name:WOLANIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3603
Mailing Address - Country:US
Mailing Address - Phone:610-789-7337
Mailing Address - Fax:
Practice Address - Street 1:1210 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3603
Practice Address - Country:US
Practice Address - Phone:610-789-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2100447516OtherDENTAL OFFICE