Provider Demographics
NPI:1588840789
Name:WOLD, ROBERT HERMAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HERMAN
Last Name:WOLD
Suffix:JR
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 1:8444 HIALEAH WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2609
Mailing Address - Country:US
Mailing Address - Phone:916-705-6334
Mailing Address - Fax:
Practice Address - Street 1:8444 HIALEAH WAY
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2609
Practice Address - Country:US
Practice Address - Phone:916-705-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice