Provider Demographics
NPI:1831293935
Name:WULF, WALTER J (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:WULF
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 CAROLINA BCH RD
Mailing Address - Street 2:AFFORDABLE DENTURES
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-343-8559
Practice Address - Street 1:2253 CAROLINA BCH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-343-0830
Practice Address - Fax:910-343-8559
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901753Medicaid