Provider Demographics
NPI:1649375973
Name:DANIEL J WADZINSKI DDS SC
Entity type:Organization
Organization Name:DANIEL J WADZINSKI DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WADZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-845-6612
Mailing Address - Street 1:109 EAST VERONA AVENUE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593
Mailing Address - Country:US
Mailing Address - Phone:608-854-6612
Mailing Address - Fax:608-845-8131
Practice Address - Street 1:109 EAST VERONA AVENUE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593
Practice Address - Country:US
Practice Address - Phone:608-854-6612
Practice Address - Fax:608-845-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38380151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty