Provider Demographics
NPI:1144300625
Name:DAVID J. WANSERSKI, DDS, MS, SC
Entity type:Organization
Organization Name:DAVID J. WANSERSKI, DDS, MS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-848-2435
Mailing Address - Street 1:550 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2901
Mailing Address - Country:US
Mailing Address - Phone:715-848-2435
Mailing Address - Fax:715-843-7769
Practice Address - Street 1:550 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2901
Practice Address - Country:US
Practice Address - Phone:715-848-2435
Practice Address - Fax:715-843-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty