Provider Demographics
NPI:1396868634
Name:WUNSCH, RUDOLF GEORGE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:GEORGE
Last Name:WUNSCH
Suffix:JR
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 1:320 AVENUE K SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4147
Mailing Address - Country:US
Mailing Address - Phone:863-293-5682
Mailing Address - Fax:863-293-8970
Practice Address - Street 1:320 AVENUE K SE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4147
Practice Address - Country:US
Practice Address - Phone:863-293-5682
Practice Address - Fax:863-293-8970
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 57741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics