Provider Demographics
NPI:1790855450
Name:WOLF, JOHN GRUVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRUVER
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 1:1250 TAMIAMI TRL N
Mailing Address - Street 2:S 107
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5248
Mailing Address - Country:US
Mailing Address - Phone:239-263-4445
Mailing Address - Fax:239-263-1558
Practice Address - Street 1:1250 TAMIAMI TRL N
Practice Address - Street 2:S 107
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5248
Practice Address - Country:US
Practice Address - Phone:239-263-4445
Practice Address - Fax:239-263-1558
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist