Provider Demographics
NPI:1205962776
Name:WOLFE, JOHN O II (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:WOLFE
Suffix:II
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 1:953 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7328
Mailing Address - Country:US
Mailing Address - Phone:301-729-1162
Mailing Address - Fax:301-729-1154
Practice Address - Street 1:953 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7328
Practice Address - Country:US
Practice Address - Phone:301-729-1162
Practice Address - Fax:301-729-1154
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice