Individual provider Active NPI

Richard Coy Wunderlich, DDS, MS

  • Periodontics
  • Canton, MI
National Provider Identifier
1083657589
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
11652 Issued in MI
Practice address
42301 Cherry Hill Rd
Suite a
Canton, MI 48188-9801
Phone
(734) 981-7477
Fax
(734) 981-0328
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 11652 MI Primary

Addresses

Primary practice location

42301 Cherry Hill Rd
Suite a
Canton, MI 48188-9801

Mailing address

42301 Cherry Hill Rd
Suite a
Canton, MI 48188-9801
Phone (734) 981-7477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160328001149 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0648228809

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
11652MIMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Wunderlich & Chang DDS, Ms, PC Periodontics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083657589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42301 CHERRY HILL RD",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481889801",
            "telephone_number": "734-981-7477",
            "fax_number": "734-981-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42301 CHERRY HILL RD",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481889801",
            "telephone_number": "734-981-7477",
            "fax_number": "734-981-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUNDERLICH",
        "first_name": "RICHARD",
        "middle_name": "COY",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "11652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.