Provider Demographics
NPI:1346344686
Name:WACHNICKI, MARION C (DMD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:C
Last Name:WACHNICKI
Suffix:
Gender:F
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:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0980
Mailing Address - Country:US
Mailing Address - Phone:603-356-5501
Mailing Address - Fax:
Practice Address - Street 1:3519 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-0980
Practice Address - Country:US
Practice Address - Phone:603-356-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics