Provider Demographics
NPI:1053319483
Name:WOLFSON, GARY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:WOLFSON
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 1:14000 E ARAPAHOE RD
Mailing Address - Street 2:#C-310
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4043
Mailing Address - Country:US
Mailing Address - Phone:303-632-6322
Mailing Address - Fax:303-632-3620
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:#C-310
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:303-632-6322
Practice Address - Fax:303-632-3620
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1047191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice