Provider Demographics
NPI:1497931968
Name:JOHN A. NERWINSKI D.D.S. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN A. NERWINSKI D.D.S. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NERWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-642-9880
Mailing Address - Street 1:384 PLACERVILLE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3939
Mailing Address - Country:US
Mailing Address - Phone:530-642-9880
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty