Healthcare Provider Details

I. General information

NPI: 1598132482
Provider Name (Legal Business Name): DANIEL WULC D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3076 SCHOENERSVILLE RD
BETHLEHEM PA
18017-2210
US

IV. Provider business mailing address

3076 SCHOENERSVILLE RD
BETHLEHEM PA
18017-2210
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-2777
  • Fax:
Mailing address:
  • Phone: 610-865-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS039506
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: