Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4883015 | WI |
NPI | 1023118973 |
---|---|
Provider Name | Dr. Donald Allen Kwarciany |
First Address | Hales Corners, WI 53130 |
Second Address | Hales Corners, WI 53130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |