Provider Demographics
NPI:1558370916
Name:WUNDERLICH, HUGH THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:THOMAS
Last Name:WUNDERLICH
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 1:32224 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3707
Mailing Address - Country:US
Mailing Address - Phone:727-789-1212
Mailing Address - Fax:727-789-3713
Practice Address - Street 1:32224 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3707
Practice Address - Country:US
Practice Address - Phone:727-789-1212
Practice Address - Fax:727-789-3713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 102061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice