1013029768 NPI number — DR. MICHAEEL JULIAN WOLFGANG DDS

Table of content: DR. MICHAEEL JULIAN WOLFGANG DDS (NPI 1013029768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013029768 NPI number — DR. MICHAEEL JULIAN WOLFGANG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFGANG
Provider First Name:
MICHAEEL
Provider Middle Name:
JULIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013029768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 MCHUGH BLVD
Provider Second Line Business Mailing Address:
2D DEN BN / NDC
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28547-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-451-2208
Provider Business Mailing Address Fax Number:
910-451-8036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MCHUGH BLVD
Provider Second Line Business Practice Location Address:
2D DEN BN / NDC
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28547-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-451-2208
Provider Business Practice Location Address Fax Number:
910-451-8036
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10355 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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