# DR. EDWARD MICHAEL WUENSCH JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1225257033
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 14594 | TX | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 14594 | STATE LICENSE \# | TX |
| 01 | — | 74-2889807 | TAX ID\# | TX |
| 01 | — | 836104 | TRICARE UNITED CONCORDIA | TX |
| 01 | — | D14594 | BLUE CROSS BLUE SHIELD | TX |