Provider Demographics
NPI:1104951813
Name:WUNSCH, PATRICE BERNADINE (DDS, M S)
Entity type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:BERNADINE
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:DDS, M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 COVE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4384
Mailing Address - Country:US
Mailing Address - Phone:410-446-4593
Mailing Address - Fax:
Practice Address - Street 1:521 N 11TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5045
Practice Address - Country:US
Practice Address - Phone:804-827-2698
Practice Address - Fax:410-448-6883
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129421223P0221X
VA04014119571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000143100Medicaid