Hans Werner Wawrousek Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

031625 Issued in NY

Practice address

122 Pine Dr
Black River, NY 13612-2110

Phone

(315) 773-0573

NPI assigned

Oct 20, 2005

Last updated

Jun 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404086400000",
    "number": "1144219197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 PINE DR",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 PINE DR",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122110",
            "telephone_number": "315-773-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAWROUSEK",
        "first_name": "HANS",
        "middle_name": "WERNER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2014-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "031625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nids Coalition Northern Chapter
• Anmmarie Tweedy Palmer
• Tammy Kelsey Perez, OTR/L
• Samantha Ann Schirmer
• Vincent a. Cesario DMD LLC
• Jessica Dawn Whitmore

• General Practice Dentistry in Black River, NY
• Providers in Black River, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.