Provider Demographics
NPI:1841678414
Name:GARY G WOLFSON, D.D.S. PLLC
Entity type:Organization
Organization Name:GARY G WOLFSON, D.D.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-632-3622
Mailing Address - Street 1:14000 E ARAPAHOE RD # C310
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4043
Mailing Address - Country:US
Mailing Address - Phone:303-632-3622
Mailing Address - Fax:303-362-3620
Practice Address - Street 1:14000 E ARAPAHOE RD # C310
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:303-632-3622
Practice Address - Fax:303-362-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty