Provider Demographics
NPI:1932398278
Name:RADWAN-WOCH, AGNIESZKA MAGDALENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:MAGDALENA
Last Name:RADWAN-WOCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JAMES DR
Mailing Address - Street 2:B33
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8866
Mailing Address - Country:US
Mailing Address - Phone:610-916-2700
Mailing Address - Fax:610-916-2701
Practice Address - Street 1:1001 JAMES DR
Practice Address - Street 2:B33
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8866
Practice Address - Country:US
Practice Address - Phone:610-916-2700
Practice Address - Fax:610-916-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice