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General NPI Number Information
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NPI Number | 1891751491
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Entity Type | Individual
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Provider Name | MICHAEL R WOLFGRAM DDS
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Gender | Male
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 11499 HIGHLAND RD
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City | HARTLAND
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State | MI
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Zip | 48353-2709
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Country | US
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Telephone | 810-632-5533
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Fax | 810-632-7556
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Provider Business Mailing Address
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Address Line | 8103 HOLLY RD
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City | GRAND BLANC
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State | MI
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Zip | 48439-1846
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Country | US
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Telephone | 810-695-2580
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Fax | 810-695-9631
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901015777
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License Number State | MI
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