Provider Demographics
NPI:1790967610
Name:WULFF, PAUL JUAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JUAN
Last Name:WULFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WILLOW CREEK RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1645
Mailing Address - Country:US
Mailing Address - Phone:928-445-3181
Mailing Address - Fax:928-445-5797
Practice Address - Street 1:1000 WILLOW CREEK RD
Practice Address - Street 2:SUITE H
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:928-445-3181
Practice Address - Fax:928-445-5797
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD3674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist