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General NPI Number Information
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NPI Number | 1659007375
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Entity Type | Organization
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Legal Business Name | WOLFRAM DENTAL CORPORATION
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 29941 AVENTURA STE B
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2015
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Country | US
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Telephone | 949-888-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 29941 AVENTURA STE B
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2015
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Country | US
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Telephone | 949-888-3333
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BENJAMIN TUINEI
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Credential |
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Telephone | 602-750-6897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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