Provider Demographics
NPI:1003425612
Name:WOLFRAM, MARKUS FRANZ (DDS)
Entity Type:Individual
Prefix:
First Name:MARKUS
Middle Name:FRANZ
Last Name:WOLFRAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARKUS
Other - Middle Name:FRANZ
Other - Last Name:WOLFRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2708 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 PERRY RD # 205
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1482
Practice Address - Country:US
Practice Address - Phone:810-515-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016004711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice