Provider Demographics
NPI:1083967467
Name:WOYCIEHOWSKY, DEMIAN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEMIAN
Middle Name:SCOTT
Last Name:WOYCIEHOWSKY
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 1:155 NE 192ND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7477
Mailing Address - Country:US
Mailing Address - Phone:360-567-5064
Mailing Address - Fax:
Practice Address - Street 1:155 NE 192ND AVE STE 105
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7477
Practice Address - Country:US
Practice Address - Phone:360-567-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9792122300000X
NV6352122300000X
WADE 60306500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist