Provider Demographics
NPI:1942821137
Name:ROBERT O WOLF DDS INC
Entity Type:Organization
Organization Name:ROBERT O WOLF DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-770-5266
Mailing Address - Street 1:24896 CHRISANTA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4800
Mailing Address - Country:US
Mailing Address - Phone:949-770-5266
Mailing Address - Fax:949-770-7534
Practice Address - Street 1:24896 CHRISANTA DR STE 110
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4800
Practice Address - Country:US
Practice Address - Phone:949-770-5266
Practice Address - Fax:949-770-7534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty