Provider Demographics
NPI:1417115254
Name:WELLNESS DENTAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:WELLNESS DENTAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:POGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-622-6288
Mailing Address - Street 1:436 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2710
Mailing Address - Country:US
Mailing Address - Phone:518-857-1876
Mailing Address - Fax:
Practice Address - Street 1:436 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2710
Practice Address - Country:US
Practice Address - Phone:518-857-1876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty