MEDICARE: DR. DANIEL CHARLES WURSTER DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS617467L	PA

General Provider Information

NPI Number	:	1417086414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL CHARLES WURSTER DDS PC

Provider Business Mailing Address
First Line	:	221 EAST THIRD STREET
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-6652
Country	:	US
Telephone Number	:	570-326-3640
Fax Number	:	570-322-3170

Provider Business Practice Location Address
First Line	:	221 EAST THIRD STREET
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-6652
Country	:	US
Telephone Number	:	570-326-3640
Fax Number	:	570-322-3170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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