Provider Demographics
NPI:1295922524
Name:WOJEWODZIC, LEROY F (DDS)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:F
Last Name:WOJEWODZIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2316
Mailing Address - Country:US
Mailing Address - Phone:734-282-2019
Mailing Address - Fax:734-282-1976
Practice Address - Street 1:2244 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2316
Practice Address - Country:US
Practice Address - Phone:734-282-2019
Practice Address - Fax:734-282-1976
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID0947200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist