Provider Demographics
NPI:1205916822
Name:WANSERSKI, DAVID J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WANSERSKI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2901
Mailing Address - Country:US
Mailing Address - Phone:715-848-2435
Mailing Address - Fax:715-843-7769
Practice Address - Street 1:550 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2901
Practice Address - Country:US
Practice Address - Phone:715-848-2435
Practice Address - Fax:715-843-7769
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics