Provider Demographics
NPI:1386852796
Name:WOLVEN, RICHARD F (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:WOLVEN
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 1:2750 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4738
Mailing Address - Country:US
Mailing Address - Phone:707-443-9413
Mailing Address - Fax:707-443-5419
Practice Address - Street 1:2750 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4738
Practice Address - Country:US
Practice Address - Phone:707-443-9413
Practice Address - Fax:707-443-5419
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist