Provider Demographics
NPI:1598872475
Name:IRZYKOWSKI, WANDA L (DDS, DMD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:L
Last Name:IRZYKOWSKI
Suffix:
Gender:F
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2111
Mailing Address - Country:US
Mailing Address - Phone:617-567-3240
Mailing Address - Fax:
Practice Address - Street 1:19 PORTER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2111
Practice Address - Country:US
Practice Address - Phone:617-567-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice