Provider Demographics
NPI:1740408582
Name:WOLF, BARRY E (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:WOLF
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 1:11407 W. BLUEMOUND RD.
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-258-0120
Mailing Address - Fax:414-259-9850
Practice Address - Street 1:11407 W. BLUEMOUND RD.
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-258-0120
Practice Address - Fax:414-259-9850
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391761468OtherEIN