Provider Demographics
NPI:1770855462
Name:WEGORZEWSKI, WITOLD RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:WITOLD
Middle Name:RICHARD
Last Name:WEGORZEWSKI
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 1:444 LAKEVILLE RD
Mailing Address - Street 2:LAKEVILLE MEDICAL CENTER SUITE 306
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-326-2510
Mailing Address - Fax:516-326-1028
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:LAKEVILLE MEDICAL CENTER SUITE 306
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-326-2510
Practice Address - Fax:516-326-1028
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist