Provider Demographics
NPI:1801896923
Name:STEVEN WOLF, DDS, PC
Entity type:Organization
Organization Name:STEVEN WOLF, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-755-2770
Mailing Address - Street 1:25916 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-6112
Mailing Address - Country:US
Mailing Address - Phone:586-755-2770
Mailing Address - Fax:586-755-1690
Practice Address - Street 1:25916 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-6112
Practice Address - Country:US
Practice Address - Phone:586-755-2770
Practice Address - Fax:586-755-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010092071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI47679OtherOMNICARE
MISW009207OtherBCBS LICENSE
MIT82976OtherHAP
MI107503OtherCARE CHOICES
MIU93813OtherHAP
4139520OtherAETNA
MI9755066630OtherBCBS
MI147805OtherGREAT LAKES HEALTH PLAN
MI664OtherGREAT LAKE HEALTH PLAN
MIRJ017024OtherBCBS
MIU93813OtherHAP
MI107503OtherCARE CHOICES
MI147805OtherGREAT LAKES HEALTH PLAN