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General NPI Number Information
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NPI Number | 1689868945
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Entity Type | Individual
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Provider Name | MICHELLE SARKISSIAN WULF D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 40 NORTHCREST DR STE 2
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-1622
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Country | US
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Telephone | 712-323-7589
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Fax | 712-323-8255
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Provider Business Mailing Address
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Address Line | 1101 COBBLESTONE DR
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City | LINCOLN
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State | NE
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Zip | 68510-4442
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Country | US
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Telephone | 712-323-7589
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Fax | 712-323-8255
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 08508
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License Number State | IA
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