Provider Demographics
NPI:1730184797
Name:WOHLRABE, DAVID CLARK (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARK
Last Name:WOHLRABE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-0546
Mailing Address - Country:US
Mailing Address - Phone:218-634-2389
Mailing Address - Fax:218-634-2381
Practice Address - Street 1:406 MAIN ST. NW
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-0546
Practice Address - Country:US
Practice Address - Phone:218-634-2389
Practice Address - Fax:218-634-2381
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND96781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN81132WOHOtherBLUE CROSS BLUE SHIELD MN