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General NPI Number Information
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NPI Number | 1821462052
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Entity Type | Organization
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Legal Business Name | WOHLFORD-SCHUETTE DENTAL, LLC
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Dates
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Enumeration Date | 11/27/2015
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Last Update Date | 11/27/2015
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Provider Practice Location Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-719-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-719-2400
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. CHRISTINE ANNE WOHLFORD
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Credential | DMD, MS
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Telephone | 618-791-2794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019028314
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License Number State | IL
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