Provider Demographics
NPI:1952309619
Name:WOLFE, BENJAMIN J (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NE 48TH AVE
Mailing Address - Street 2:STE. 1400
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4904
Mailing Address - Country:US
Mailing Address - Phone:503-844-6550
Mailing Address - Fax:503-844-7121
Practice Address - Street 1:1200 NE 48TH AVE
Practice Address - Street 2:STE. 1400
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4904
Practice Address - Country:US
Practice Address - Phone:503-844-6550
Practice Address - Fax:503-844-7121
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice