Provider Demographics
NPI:1255706347
Name:WOLF, MICHAEL BARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:WOLF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2611 INNSBRUCK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6376
Mailing Address - Country:US
Mailing Address - Phone:769-571-4837
Mailing Address - Fax:763-571-0074
Practice Address - Street 1:2611 INNSBRUCK DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6376
Practice Address - Country:US
Practice Address - Phone:769-571-4837
Practice Address - Fax:763-571-0074
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist