Provider Demographics
NPI:1194975276
Name:WUNDERLICH & CHANG DDS, MS, PC
Entity type:Organization
Organization Name:WUNDERLICH & CHANG DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WUNDERLILCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-981-7474
Mailing Address - Street 1:42301 CHERRY HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-9801
Mailing Address - Country:US
Mailing Address - Phone:734-981-7477
Mailing Address - Fax:734-981-0328
Practice Address - Street 1:42301 CHERRY HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-9801
Practice Address - Country:US
Practice Address - Phone:734-981-7477
Practice Address - Fax:734-981-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJ800274OtherBLUE CROSS BLUE SHIELD