Individual provider Active NPI

Joseph Jude Wawrzeniak, D.M.D.

  • General Practice Dentistry
  • Irwin, PA
National Provider Identifier
1942351903
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS020324L Issued in PA
Practice address
13370 Route 30
Irwin, PA 15642-1129
Phone
(724) 863-2077
Fax
(724) 863-2089
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 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 DS020324L PA Primary

Addresses

Primary practice location

13370 Route 30
Irwin, PA 15642-1129

Mailing address

13370 Route 30
Irwin, PA 15642-1129
Phone (724) 863-2077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20150520001982 PA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0749500445

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS020324LPAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942351903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13370 ROUTE 30",
            "city": "IRWIN",
            "state": "PA",
            "postal_code": "156421129",
            "telephone_number": "724-863-2077",
            "fax_number": "724-863-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13370 ROUTE 30",
            "city": "IRWIN",
            "state": "PA",
            "postal_code": "156421129",
            "telephone_number": "724-863-2077",
            "fax_number": "724-863-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAWRZENIAK",
        "first_name": "JOSEPH",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS020324L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irwin, PA

Sources for this page

Verify at the official NPI Registry.