Individual
DR. JOHN JOSEPH WIDLAK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
163 LEDGEWOOD RD, APT 412, GROTON, CT 06340-6611
(505) 491-7009
Mailing address
1 WAHOO DRIVE, NAVAL BRANCH HEALTH CLINIC, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
008204
CT
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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