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NPI Code Detail

MEDICARE: DR. JOHN WESLEY VOLLENWEIDER DMD

MEDICARE: DR. JOHN WESLEY VOLLENWEIDER DMD
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
11223G0001XGeneral Practice Dentistry9011GA

General Provider Information

NPI Number : 1508868613
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN WESLEY VOLLENWEIDER DMD
Provider Business Mailing Address
First Line : 210 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-882-2551
Fax Number : 706-845-0469
Provider Business Practice Location Address
First Line : 210 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-882-2551
Fax Number : 706-845-0469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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