Provider Demographics
NPI:1295428878
Name:WESOLOWSKI, CHRISTIAN JOSEPH
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOSEPH
Last Name:WESOLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E MAIN ST STE 2206
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2476
Mailing Address - Country:US
Mailing Address - Phone:774-991-2856
Mailing Address - Fax:
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6636
Practice Address - Country:US
Practice Address - Phone:781-893-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist