Provider Demographics
NPI:1801935754
Name:WAWERSKA, AGNIESZKA (DDS)
Entity type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:
Last Name:WAWERSKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:BARTYS-WAWERSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2826 N 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2061
Mailing Address - Country:US
Mailing Address - Phone:623-535-1705
Mailing Address - Fax:
Practice Address - Street 1:7102 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8390
Practice Address - Country:US
Practice Address - Phone:602-242-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD62491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151409OtherAHCCCS PROVIDER ID