Provider Demographics
NPI:1255345666
Name:YAWORSKI, DENNIS SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SAMUEL
Last Name:YAWORSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 BURKE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1827
Mailing Address - Country:US
Mailing Address - Phone:713-943-2300
Mailing Address - Fax:713-943-2821
Practice Address - Street 1:3315 BURKE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1827
Practice Address - Country:US
Practice Address - Phone:713-943-2300
Practice Address - Fax:713-943-2821
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JK74OtherBC/BS/TX
TXB27721Medicare UPIN
TX00JK74Medicare ID - Type Unspecified