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General NPI Number Information
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NPI Number | 1295902096
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Entity Type | Individual
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Provider Name | NATHAN AUGUSTIN WUEBBELS DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 150 BERGEN ST ROOM C401
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City | NEWARK
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State | NJ
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Zip | 07103-2496
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Country | US
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Telephone | 973-972-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 689 MARIN BLVD APT. 1010
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City | JERSEY CITY
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State | NJ
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Zip | 07310-1260
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Country | US
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Telephone | 618-660-5809
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.026729
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DI02440600
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License Number State | NJ
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