Healthcare Provider Details

I. General information

NPI: 1114651072
Provider Name (Legal Business Name): MATTHEW K WURZEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 WESTMORELAND AVE
NAPOLEON OH
43545-1260
US

IV. Provider business mailing address

12335 WATERSTONE LN APT 810
PERRYSBURG OH
43551-3043
US

V. Phone/Fax

Practice location:
  • Phone: 877-216-9296
  • Fax:
Mailing address:
  • Phone: 419-351-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: