Provider Demographics
NPI:1114947108
Name:WOLFE, DAVID J
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WOLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3465
Mailing Address - Country:US
Mailing Address - Phone:909-383-8931
Mailing Address - Fax:909-383-0516
Practice Address - Street 1:1881 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 7A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-383-8931
Practice Address - Fax:909-383-0516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics