Provider Demographics
NPI:1245768274
Name:WACLAW, MONIKA MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:MARIA
Last Name:WACLAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GETTY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2161
Mailing Address - Country:US
Mailing Address - Phone:630-450-6893
Mailing Address - Fax:
Practice Address - Street 1:600 GETTY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2161
Practice Address - Country:US
Practice Address - Phone:973-594-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031099122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program