Provider Demographics
NPI:1417175886
Name:WOOLF, DANIEL JARED (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JARED
Last Name:WOOLF
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 1:501 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-4739
Mailing Address - Country:US
Mailing Address - Phone:919-552-5113
Mailing Address - Fax:919-552-2193
Practice Address - Street 1:320 W RANSOM ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2432
Practice Address - Country:US
Practice Address - Phone:919-552-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice