Provider Demographics
NPI:1962505560
Name:WIROSLOFF, MICHAEL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:WIROSLOFF
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 1:35 WITLENS WAY
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-998-8588
Mailing Address - Fax:302-998-1189
Practice Address - Street 1:5185 W WOODMILL DRIVE
Practice Address - Street 2:STE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-996-6477
Practice Address - Fax:302-998-1189
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100008911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice