Provider Demographics
NPI:1194094789
Name:WOLFINGER, GLENN J (DMD,FACP)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:J
Last Name:WOLFINGER
Suffix:
Gender:M
Credentials:DMD,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:467 PENNSYLVANIA AVE
Mailing Address - Street 2:SUIE 201
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3420
Mailing Address - Country:US
Mailing Address - Phone:215-646-6334
Mailing Address - Fax:215-643-1149
Practice Address - Street 1:467 PENNSYLVANIA AVE
Practice Address - Street 2:SUIE 201
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3420
Practice Address - Country:US
Practice Address - Phone:215-646-6334
Practice Address - Fax:215-643-1149
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0273191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics