Provider Demographics
NPI:1003824863
Name:WOLOV, MICHAEL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:WOLOV
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 1:81 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4020
Mailing Address - Country:US
Mailing Address - Phone:617-901-1382
Mailing Address - Fax:561-626-5505
Practice Address - Street 1:81 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4020
Practice Address - Country:US
Practice Address - Phone:617-901-1382
Practice Address - Fax:561-626-5505
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121321223E0200X
NY50 0571311223E0200X
FLDN 126431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics