Individual
DR. AGNIESZKA WAWERSKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
7102 N 35TH AVE, PHOENIX, AZ 85051-8390
(602) 242-1996
Mailing address
2826 N 151ST AVE, GOODYEAR, AZ 85338-2061
(623) 535-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6249
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151409
AHCCCS PROVIDER ID
AZ
Enumeration date
02/06/2007
Last updated
07/08/2007
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