Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 013956 | MO |
NPI | 1154371342 |
---|---|
Provider Name | Dr. Keith A. Wunsch |
First Address | Columbia, MD 21044-6040 |
Second Address | Fort Meade, MD 20755-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |