Provider Demographics
NPI:1346221108
Name:WOLF, PAUL LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LOUIS
Last Name:WOLF
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 1:601 W US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2656
Mailing Address - Country:US
Mailing Address - Phone:219-322-0501
Mailing Address - Fax:219-322-0577
Practice Address - Street 1:601 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2656
Practice Address - Country:US
Practice Address - Phone:219-322-0501
Practice Address - Fax:219-322-0577
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010083A1223S0112X
IN12010083204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00111143OtherRAILROAD MEDICARE NUMBER
IN000000084422OtherBC BS PROVIDER PIN NUMBER
IN200196800Medicaid
IN986521OtherUNITED CONCORDIA NUMBER
IN000000084422OtherBC BS PROVIDER PIN NUMBER
IN986521OtherUNITED CONCORDIA NUMBER