Healthcare Provider Details

I. General information

NPI: 1063514826
Provider Name (Legal Business Name): ARTHUR CHARLES WULWICK D.DS.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 NORTH JOSEY LANE; SUITE #114
CARROLLTON TX
75007-5541
US

IV. Provider business mailing address

2630 NORTH JOSEY LANE; SUITE #114
CARROLLTON TX
75007-5541
US

V. Phone/Fax

Practice location:
  • Phone: 972-245-4546
  • Fax: 972-446-0586
Mailing address:
  • Phone: 972-245-4546
  • Fax: 972-446-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: