Provider Demographics
NPI:1376636894
Name:PIENKOWSKI, WALTER E (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:PIENKOWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WHITE ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4039
Mailing Address - Country:US
Mailing Address - Phone:732-530-0304
Mailing Address - Fax:732-530-8060
Practice Address - Street 1:20 WHITE ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4039
Practice Address - Country:US
Practice Address - Phone:732-530-0304
Practice Address - Fax:732-530-8060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0090991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103479OtherCIGNA INSURANCE
NJ169629OtherUNITED CONCORDIA INSURANC