Provider Demographics
NPI:1346264041
Name:WOJTKUN, PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:WOJTKUN
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 1:351 NORTH MAIN ST
Mailing Address - Street 2:PO BOX 3268
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0805
Mailing Address - Country:US
Mailing Address - Phone:978-475-1030
Mailing Address - Fax:978-475-0030
Practice Address - Street 1:351 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2610
Practice Address - Country:US
Practice Address - Phone:978-475-1030
Practice Address - Fax:978-475-0030
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11578OtherBLUE CROSS BLUE SHIELD OF