Provider Demographics
NPI:1942351903
Name:WAWRZENIAK, JOSEPH JUDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JUDE
Last Name:WAWRZENIAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13370 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1129
Mailing Address - Country:US
Mailing Address - Phone:724-863-2077
Mailing Address - Fax:724-863-2089
Practice Address - Street 1:13370 ROUTE 30
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1129
Practice Address - Country:US
Practice Address - Phone:724-863-2077
Practice Address - Fax:724-863-2089
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020324L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice