Healthcare Provider Details

I. General information

NPI: 1144063298
Provider Name (Legal Business Name): MICHAEL WOLFGRAM DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8103 HOLLY RD
GRAND BLANC MI
48439-1846
US

IV. Provider business mailing address

8103 HOLLY RD
GRAND BLANC MI
48439-1846
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-2580
  • Fax:
Mailing address:
  • Phone: 810-695-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL WOLFGRAM
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 810-814-3053