Provider Demographics
NPI: | 1730297219 |
---|---|
Name: | WOHAR, ROBERT MICHAEL (DMD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ROBERT |
Middle Name: | MICHAEL |
Last Name: | WOHAR |
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: | 357 SOUTH GULPH ROAD |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | KING OF PRUSSIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19406-3174 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-337-7100 |
Mailing Address - Fax: | 610-992-0190 |
Practice Address - Street 1: | 357 SOUTH GULPH ROAD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | KING OF PRUSSIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19406-3174 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-337-7100 |
Practice Address - Fax: | 610-992-0190 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-26 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DS019503L | 1223S0112X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
0048320000 | Other | KEYSTONE & BLUE SHIELD | |
D3895 | Other | AETNA | |
123458 | Other | UNITED CONCORDIA | |
D3895 | Other | AETNA | |
123458 | Other | UNITED CONCORDIA |