Healthcare Provider Details

I. General information

NPI: 1194975276
Provider Name (Legal Business Name): WUNDERLICH & CHANG DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42301 CHERRY HILL RD SUITE A
CANTON MI
48188-9801
US

IV. Provider business mailing address

42301 CHERRY HILL RD SUITE A
CANTON MI
48188-9801
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-7477
  • Fax: 734-981-0328
Mailing address:
  • Phone: 734-981-7477
  • Fax: 734-981-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD C WUNDERLILCH
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 734-981-7474