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General NPI Number Information
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NPI Number | 1326673880
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Entity Type | Organization
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Legal Business Name | CHARLES WOHLWEND DDSPC
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 1044 EAGLERIDGE BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2130
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Country | US
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Telephone | 719-542-1212
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Fax | 719-544-3854
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Provider Business Mailing Address
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Address Line | 1044 EAGLERIDGE BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2130
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Country | US
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Telephone | 719-542-1212
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Fax | 719-544-3854
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CHARLES WOHLWEND
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Credential | DDS
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Telephone | 719-542-1212
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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 |
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License Number State |
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