Provider Demographics
NPI:1669559407
Name:WASKO, STEVEN (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WASKO
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:LAKE HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:18624-0293
Mailing Address - Country:US
Mailing Address - Phone:570-722-8545
Mailing Address - Fax:570-722-4023
Practice Address - Street 1:ROUTE 903
Practice Address - Street 2:
Practice Address - City:LAKE HARMONY
Practice Address - State:PA
Practice Address - Zip Code:18624
Practice Address - Country:US
Practice Address - Phone:570-722-9545
Practice Address - Fax:570-722-4023
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020893L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist