Provider Demographics
NPI:1013185990
Name:WOLVEN, JASON F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:F
Last Name:WOLVEN
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 1:831 HARRIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4541
Mailing Address - Country:US
Mailing Address - Phone:707-445-1301
Mailing Address - Fax:707-445-0151
Practice Address - Street 1:831 HARRIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4541
Practice Address - Country:US
Practice Address - Phone:707-445-1301
Practice Address - Fax:707-445-0151
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice