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General NPI Number Information
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NPI Number | 1194975276
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Entity Type | Organization
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Legal Business Name | WUNDERLICH & CHANG DDS, MS, PC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 42301 CHERRY HILL RD SUITE A
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City | CANTON
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State | MI
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Zip | 48188-9801
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Country | US
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Telephone | 734-981-7477
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Fax | 734-981-0328
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Provider Business Mailing Address
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Address Line | 42301 CHERRY HILL RD SUITE A
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City | CANTON
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State | MI
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Zip | 48188-9801
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Country | US
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Telephone | 734-981-7477
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Fax | 734-981-0328
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD C WUNDERLILCH
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Credential | DDS, MS
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Telephone | 734-981-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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