Provider Demographics
NPI:1225257033
Name:WUENSCH, EDWARD MICHAEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:WUENSCH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:245 HUNTERS VILLAGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:830-629-9000
Mailing Address - Fax:830-629-0299
Practice Address - Street 1:245 HUNTERS VILLAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4742
Practice Address - Country:US
Practice Address - Phone:830-629-9000
Practice Address - Fax:830-629-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX836104OtherTRICARE UNITED CONCORDIA
TX14594OtherSTATE LICENSE #
TX74-2889807OtherTAX ID#
TXD14594OtherBLUE CROSS BLUE SHIELD
TXBW6526327OtherDEA#
TX74-2889807OtherTIN