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NPI Code Detail

MEDICARE: DR. WAYNE ERVIN PUNDT D.D.S

MEDICARE:  DR. WAYNE ERVIN PUNDT  D.D.S
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
1122300000XDentist10225TX

General Provider Information

NPI Number : 1275535130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAYNE ERVIN PUNDT D.D.S
Provider Business Mailing Address
First Line : 421 N 38TH ST
Second Line :
City : KILLEEN
State : TX
Zip : 76543-4153
Country : US
Telephone Number : 254-634-0234
Fax Number : 254-634-5307
Provider Business Practice Location Address
First Line : 421 N 38TH ST
Second Line :
City : KILLEEN
State : TX
Zip : 76543-4153
Country : US
Telephone Number : 254-634-0234
Fax Number : 254-634-5307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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Directions to “ DR. WAYNE ERVIN PUNDT D.D.S” Practice Location

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