Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D13786 | MN |
N | 122300000X | Dentist | DN21129 | FL |
Y | 1223P0700X | Prosthodontist | 0401415962 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D13786 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | D13786 | MN |
NPI | 1174054282 |
---|---|
Provider Name | Dr. Pandora Keala Lee Wojnarwsky |
First Address | Richmond, VA 23298-5045 |
Second Address | Richmond, VA 23298-5064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 22/03/2019 |