Healthcare Provider Details

I. General information

NPI: 1104951813
Provider Name (Legal Business Name): PATRICE BERNADINE WUNSCH D.D.S., M. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N 11TH ST
RICHMOND VA
23298-5045
US

IV. Provider business mailing address

3019 COVE VIEW LN
MIDLOTHIAN VA
23112-4384
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-2698
  • Fax: 410-448-6883
Mailing address:
  • Phone: 410-446-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12942
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401411957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: