Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2929 | WI |
NPI | 1205916822 |
---|---|
Provider Name | Dr. David J Wanserski |
First Address | Wausau, WI 54401-2901 |
Second Address | Wausau, WI 54401-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |