Provider Demographics
NPI:1700860608
Name:WOLFE, STANLEY JACK (DDS)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JACK
Last Name:WOLFE
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 1:385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4312
Mailing Address - Country:US
Mailing Address - Phone:203-933-3131
Mailing Address - Fax:203-934-4938
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4312
Practice Address - Country:US
Practice Address - Phone:203-933-3131
Practice Address - Fax:203-934-4938
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics