Provider Demographics
NPI:1164647327
Name:NERWINSKI, JOHN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:NERWINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 OAK CREST CIR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3454
Mailing Address - Country:US
Mailing Address - Phone:530-642-1409
Mailing Address - Fax:530-642-1409
Practice Address - Street 1:384 PLACERVILLE DR
Practice Address - Street 2:SUITE H
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3939
Practice Address - Country:US
Practice Address - Phone:530-642-9880
Practice Address - Fax:530-642-1409
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD23857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist