Provider Demographics
NPI:1821078981
Name:WOLF, ERWIN H II (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:H
Last Name:WOLF
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 BERKSHIRE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-374-4093
Mailing Address - Fax:610-375-6454
Practice Address - Street 1:1075 BERKSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-374-4093
Practice Address - Fax:610-375-6454
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS017170204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28048Medicare ID - Type Unspecified