Individual
DONALD GARY WOLFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
22811 MACK AVE, L1, ST CLAIR SHORES, MI 48080-2021
(586) 777-1331
(586) 777-2358
Mailing address
22811 MACK AVE, L1, ST 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
11/30/2005
Last updated
07/13/2010
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