Individual provider Active NPI

Michael Alan Wojdylak, D.D.S.

  • General Practice Dentistry
  • Harrisburg, PA
National Provider Identifier
1235310160
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS026613L Issued in PA
Practice address
61 Roosevelt St
Harrisburg, PA 17111-4143
Phone
(717) 561-2275
Fax
(717) 561-2646
NPI assigned
Nov 20, 2007
Last updated
Nov 20, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS026613L PA Primary

Addresses

Primary practice location

61 Roosevelt St
Harrisburg, PA 17111-4143

Mailing address

61 Roosevelt St
Harrisburg, PA 17111-4143
Phone (717) 561-2275

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DS026613LPAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1235310160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 ROOSEVELT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171114143",
            "telephone_number": "717-561-2275",
            "fax_number": "717-561-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 ROOSEVELT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171114143",
            "telephone_number": "717-561-2275",
            "fax_number": "717-561-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOJDYLAK",
        "first_name": "MICHAEL",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS026613L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.