Provider Demographics
NPI:1992015721
Name:WOLLMANN, JOSEF MANFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:MANFRED
Last Name:WOLLMANN
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 1:109 S 6TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2541
Mailing Address - Country:US
Mailing Address - Phone:956-787-3317
Mailing Address - Fax:
Practice Address - Street 1:109 S 6TH ST
Practice Address - Street 2:STE A
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2541
Practice Address - Country:US
Practice Address - Phone:956-787-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00260781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice