Provider Demographics
NPI:1487788204
Name:WEGRZYN DENTAL GROUP INC
Entity type:Organization
Organization Name:WEGRZYN DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WEGRZYN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-592-8099
Mailing Address - Street 1:391 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1929
Mailing Address - Country:US
Mailing Address - Phone:413-592-8099
Mailing Address - Fax:413-592-5839
Practice Address - Street 1:391 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1929
Practice Address - Country:US
Practice Address - Phone:413-592-8099
Practice Address - Fax:413-592-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1426492OtherUNITED CONCORDIA TRI CARE
MAX11395OtherBCBS MASS