Healthcare Provider Details

I. General information

NPI: 1417920133
Provider Name (Legal Business Name): ROBERT ALAN WUNSCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PENN AVE
WYOMISSING PA
19610-2136
US

IV. Provider business mailing address

1500 PENN AVE
WYOMISSING PA
19610-2136
US

V. Phone/Fax

Practice location:
  • Phone: 610-372-6606
  • Fax: 610-685-2448
Mailing address:
  • Phone: 610-372-6606
  • Fax: 610-685-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-027865-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: