Provider Demographics
NPI:1588699029
Name:BUESCHGEN, WOLF D (DMD)
Entity type:Individual
Prefix:
First Name:WOLF
Middle Name:D
Last Name:BUESCHGEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CHARLIE HALL BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5830
Mailing Address - Country:US
Mailing Address - Phone:843-763-5665
Mailing Address - Fax:843-766-7376
Practice Address - Street 1:2060 CHARLIE HALL BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5830
Practice Address - Country:US
Practice Address - Phone:843-763-5665
Practice Address - Fax:843-766-7376
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice