Provider Demographics
NPI:1851590707
Name:WOJTASIEWICZ, ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:WOJTASIEWICZ
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 1:6129 81ST ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1403
Mailing Address - Country:US
Mailing Address - Phone:347-255-3630
Mailing Address - Fax:
Practice Address - Street 1:6129 81ST ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1403
Practice Address - Country:US
Practice Address - Phone:347-255-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP58617122300000X
NY0542051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist