Organization
D GARY WOLFORD DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD G WOLFORD DDS (OWNER)
(586) 777-1331
Entity
Organization
Contact information
Practice address
22811 MACK AVE, SUITE L-1, SAINT CLAIR SHORES, MI 48080-2021
(586) 777-1331
(586) 777-2358
Mailing address
22811 MACK AVE, SUITE L-1, SAINT CLAIR SHORES, MI 48080-2021
(586) 777-1331
(586) 777-2358
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2901010985
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102991246
—
MI
01
—
9755060680
BLUE CROSS BLUE SHIELD
MI
Enumeration date
11/30/2010
Last updated
10/27/2015
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