Provider Demographics
NPI:1083637664
Name:WASKOWITZ, JOSHUA
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:WASKOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 480
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9601
Mailing Address - Country:US
Mailing Address - Phone:412-784-0228
Mailing Address - Fax:412-784-0458
Practice Address - Street 1:369 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-9601
Practice Address - Country:US
Practice Address - Phone:412-784-0228
Practice Address - Fax:412-784-0458
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0353991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008387390001Medicaid