=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992871305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT WOHRMAN DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1711 KIRBY PKWY
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-591-1526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1711 KIRBY PKWY
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-591-1526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. ROBERT EDWARD WOHRMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 901-591-1526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS3734
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------