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General NPI Number Information
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NPI Number | 1104951813
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Entity Type | Individual
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Provider Name | PATRICE BERNADINE WUNSCH D.D.S., M. S.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 521 N 11TH ST
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City | RICHMOND
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State | VA
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Zip | 23298-5045
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Country | US
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Telephone | 804-827-2698
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Fax | 410-448-6883
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Provider Business Mailing Address
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Address Line | 3019 COVE VIEW LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4384
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Country | US
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Telephone | 410-446-4593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12942
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401411957
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License Number State | VA
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