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General NPI Number Information
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NPI Number | 1891218392
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Entity Type | Individual
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Provider Name | MATTHEW GARY WOLD DMD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5040 E 2ND ST STE 2
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City | CASPER
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State | WY
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Zip | 82609-4468
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Country | US
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Telephone | 307-462-3752
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Fax | 307-337-4929
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Provider Business Mailing Address
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Address Line | 5040 E 2ND ST STE 2
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City | CASPER
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State | WY
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Zip | 82609-4468
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Country | US
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Telephone | 307-462-3752
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Fax | 307-337-4929
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1484
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License Number State | WY
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