Healthcare Provider Details

I. General information

NPI: 1871519033
Provider Name (Legal Business Name): PETER S WOHRLE DMD, M.MED SC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR # 601
NEWPORT BEACH CA
92660-7853
US

IV. Provider business mailing address

360 SAN MIGUEL DR # 601
NEWPORT BEACH CA
92660-7853
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-8072
  • Fax: 949-720-8073
Mailing address:
  • Phone: 949-720-8072
  • Fax: 949-720-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: