Provider Demographics
NPI:1386832517
Name:JUNE K. WOLFF DMD
Entity Type:Organization
Organization Name:JUNE K. WOLFF DMD
Other - Org Name:CLAYTON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-727-4900
Mailing Address - Street 1:168 N MERAMEC AVE
Mailing Address - Street 2:#102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3758
Mailing Address - Country:US
Mailing Address - Phone:314-727-4900
Mailing Address - Fax:314-727-9888
Practice Address - Street 1:168 N MERAMEC AVE
Practice Address - Street 2:#102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3758
Practice Address - Country:US
Practice Address - Phone:314-727-4900
Practice Address - Fax:314-727-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0143961223G0001X
MO0144161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty