Provider Demographics
NPI:1487883161
Name:WYRWA, STEPHEN J (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:WYRWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 FINDERNE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3046
Mailing Address - Country:US
Mailing Address - Phone:908-722-6116
Mailing Address - Fax:
Practice Address - Street 1:216 FINDERNE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3046
Practice Address - Country:US
Practice Address - Phone:908-722-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI2120600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist