Provider Demographics
NPI:1558668665
Name:WILLIAM WOLFERSBERGER DMD PC
Entity Type:Organization
Organization Name:WILLIAM WOLFERSBERGER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-748-5765
Mailing Address - Street 1:655 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3325
Mailing Address - Country:US
Mailing Address - Phone:718-748-5765
Mailing Address - Fax:718-748-5730
Practice Address - Street 1:655 76TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3325
Practice Address - Country:US
Practice Address - Phone:718-748-5765
Practice Address - Fax:718-748-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1194867010OtherMDICARE TYPE 1 NPI
NY1194867010OtherMDICARE TYPE 1 NPI