| Charles Wohlwend Ddspc | |
|
1044 Eagleridge Blvd Pueblo CO 81008-2130 | |
| (719) 542-1212 | |
| (719) 544-3854 |
| Full Name | Charles Wohlwend Ddspc |
|---|---|
| Speciality | Dentist |
| Location | 1044 Eagleridge Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Charles Wohlwend (OWNER/DENTIST) |
| Authorized Official Contact | 7195421212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Wohlwend Ddspc 1044 Eagleridge Blvd Pueblo CO 81008-2130 Ph: (719) 542-1212 | Charles Wohlwend Ddspc 1044 Eagleridge Blvd Pueblo CO 81008-2130 Ph: (719) 542-1212 |
| NPI Number | 1326673880 |
|---|---|
| Provider Enumeration Date | 03/05/2020 |
| Last Update Date | 03/05/2020 |
| Medicare PECOS PAC ID | 8022431055 |
|---|---|
| Medicare Enrollment ID | O20200709002863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326673880 | NPI | - | NPPES |
| 30 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Charles Wohlwend |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366423279 PECOS PAC ID: 7618269507 Enrollment ID: I20200709002968 |
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