1760593008 NPI number — ROLAND P WOLFERSTETTER DDS LLC

Table of content: GEORGE WM. BENSCH M.D. (NPI 1508839457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760593008 NPI number — ROLAND P WOLFERSTETTER DDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROLAND P WOLFERSTETTER DDS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1760593008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9235 W CAPITOL DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53222-1567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-464-8600
Provider Business Mailing Address Fax Number:
414-464-8603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9235 W CAPITOL DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-1567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-464-8600
Provider Business Practice Location Address Fax Number:
414-464-8603
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFERSTETTER
Authorized Official First Name:
ROLAND
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
414-464-8600

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5002074 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 333 72 700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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