Provider Demographics
NPI:1881868842
Name:STANLEYJWOLFEDDSPC
Entity type:Organization
Organization Name:STANLEYJWOLFEDDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-933-3131
Mailing Address - Street 1:385 MAIN ST
Mailing Address - Street 2:SUITE4
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4312
Mailing Address - Country:US
Mailing Address - Phone:203-933-3131
Mailing Address - Fax:203-934-4938
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:SUITE4
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4312
Practice Address - Country:US
Practice Address - Phone:203-933-3131
Practice Address - Fax:203-934-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002039493Medicaid