Provider Demographics
NPI:1821083296
Name:WOLFE, DOUGLAS ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANDREW
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 1:609 COTTONFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9387
Mailing Address - Country:US
Mailing Address - Phone:330-348-6024
Mailing Address - Fax:
Practice Address - Street 1:1532 PROVIDENCE ROAD SOUTH
Practice Address - Street 2:SUITE 220
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-373-6040
Practice Address - Fax:704-373-6041
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-216911223G0001X
NC89091223G0001X
FL184441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice