Provider Demographics
NPI:1629095526
Name:ROBERT H. WOOLF, DDS, PC
Entity Type:Organization
Organization Name:ROBERT H. WOOLF, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-635-3584
Mailing Address - Street 1:320 A AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3056
Mailing Address - Country:US
Mailing Address - Phone:503-635-3584
Mailing Address - Fax:503-635-6813
Practice Address - Street 1:320 A AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3056
Practice Address - Country:US
Practice Address - Phone:503-635-3584
Practice Address - Fax:503-635-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD52351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty