Provider Demographics
NPI:1114651072
Name:WURZEL, MATTHEW K (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:WURZEL
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 1:12335 WATERSTONE LN APT 810
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3043
Mailing Address - Country:US
Mailing Address - Phone:419-351-4441
Mailing Address - Fax:
Practice Address - Street 1:875 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1260
Practice Address - Country:US
Practice Address - Phone:877-216-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist