Provider Demographics
NPI:1366539348
Name:WASIELEWSKI, JAMES PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILIP
Last Name:WASIELEWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FOXCROFT RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2734
Mailing Address - Country:US
Mailing Address - Phone:315-797-6827
Mailing Address - Fax:
Practice Address - Street 1:314 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1911
Practice Address - Country:US
Practice Address - Phone:315-866-2790
Practice Address - Fax:315-867-5979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512431223G0001X
FLDN 177191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice