MEDICARE: GEORGE J. WULFEKOTTE JR. DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4155	OK

General Provider Information

NPI Number	:	1053586867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE J. WULFEKOTTE JR. DDS PC

Provider Business Mailing Address
First Line	:	8283 S WALKER AVE
Second Line	:	SUITE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9413
Country	:	US
Telephone Number	:	405-632-5562
Fax Number	:	405-632-7717

Provider Business Practice Location Address
First Line	:	8283 S WALKER AVE
Second Line	:	SUITE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9413
Country	:	US
Telephone Number	:	405-632-5562
Fax Number	:	405-632-7717

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE J. WULFEKOTTE JR.
Credential	:	DDS
Telephone Number	:	405-632-5562

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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