Provider Demographics
NPI:1447396932
Name:WULLSCHLAGER, GARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:WULLSCHLAGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S EL MOLINO AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2985
Mailing Address - Country:US
Mailing Address - Phone:626-796-5591
Mailing Address - Fax:626-796-7769
Practice Address - Street 1:200 S EL MOLINO AVE STE 4
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2985
Practice Address - Country:US
Practice Address - Phone:626-796-5591
Practice Address - Fax:626-796-7769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice