Provider Demographics
NPI:1033290424
Name:WOLF, LOUIS ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ROBERT
Last Name:WOLF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:488 MADISON AVE
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5702
Mailing Address - Country:US
Mailing Address - Phone:212-223-0320
Mailing Address - Fax:212-371-1074
Practice Address - Street 1:488 MADISON AVE
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5702
Practice Address - Country:US
Practice Address - Phone:212-223-0320
Practice Address - Fax:212-371-1074
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery