MEDICARE: DR. WALTER S. VUCHNICH D.D.S., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5060	NC

General Provider Information

NPI Number	:	1861601684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER S. VUCHNICH D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1028 LEE ANN DR NE
Second Line	:	SUITE 300
City	:	CONCORD
State	:	NC
Zip	:	28025-2903
Country	:	US
Telephone Number	:	704-782-5146
Fax Number	:	704-784-2002

Provider Business Practice Location Address
First Line	:	1028 LEE ANN DR NE
Second Line	:	SUITE 300
City	:	CONCORD
State	:	NC
Zip	:	28025-2903
Country	:	US
Telephone Number	:	704-782-5146
Fax Number	:	704-784-2002

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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