Provider Demographics
NPI:1104514777
Name:DOUGLAS A. WOLFE DDS PLLC
Entity type:Organization
Organization Name:DOUGLAS A. WOLFE DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-348-6024
Mailing Address - Street 1:1532 PROVIDENCE RD S STE 220
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8313
Mailing Address - Country:US
Mailing Address - Phone:704-373-6040
Mailing Address - Fax:704-373-6041
Practice Address - Street 1:1532 PROVIDENCE RD S STE 220
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8313
Practice Address - Country:US
Practice Address - Phone:704-373-6040
Practice Address - Fax:704-373-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty