Provider Demographics
NPI:1871635425
Name:DR STANLEY J WASKO , DDS & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DR STANLEY J WASKO , DDS & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-331-1330
Mailing Address - Street 1:3428 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2610
Mailing Address - Country:US
Mailing Address - Phone:215-331-1330
Mailing Address - Fax:215-331-3394
Practice Address - Street 1:3428 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2610
Practice Address - Country:US
Practice Address - Phone:215-331-1330
Practice Address - Fax:215-331-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026266L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty