Provider Demographics
NPI:1235263567
Name:WOLLSCHLAGER, THOMAS P (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:WOLLSCHLAGER
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 1:2167 CRAWFORDVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1035
Mailing Address - Country:US
Mailing Address - Phone:850-926-7700
Mailing Address - Fax:850-926-1477
Practice Address - Street 1:2167 CRAWFORDVILLE HWY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1035
Practice Address - Country:US
Practice Address - Phone:850-926-7700
Practice Address - Fax:850-926-1477
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00140551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice