Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 019022816 | IL |
NPI | 1053660035 |
---|---|
Provider Name | Dr. John Wazio JR. |
First Address | Batavia, IL 60510-2452 |
Second Address | Batavia, IL 60510-2452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 05/09/2012 |