Provider Demographics
NPI:1134349160
Name:WOLFE, LLOYD B JR (DMD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:B
Last Name:WOLFE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:406 BRIARWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3059
Mailing Address - Country:US
Mailing Address - Phone:601-957-9200
Mailing Address - Fax:601-957-2060
Practice Address - Street 1:406 BRIARWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3059
Practice Address - Country:US
Practice Address - Phone:601-957-9200
Practice Address - Fax:601-957-2060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2108841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics