Provider Demographics
NPI:1437460011
Name:WUNDERLE, ROBERT C III (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WUNDERLE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG H
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2114
Mailing Address - Country:US
Mailing Address - Phone:770-977-0364
Mailing Address - Fax:678-483-8487
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:BLDG H
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:770-977-0364
Practice Address - Fax:678-483-8487
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0146991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery