Healthcare Provider Details

I. General information

NPI: 1588699029
Provider Name (Legal Business Name): WOLF D BUESCHGEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHARLIE HALL BLVD SUITE 5A
CHARLESTON SC
29414-5830
US

IV. Provider business mailing address

2060 CHARLIE HALL BLVD SUITE 5A
CHARLESTON SC
29414-5830
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-5665
  • Fax: 843-766-7376
Mailing address:
  • Phone: 843-763-5665
  • Fax: 843-766-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3961
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: