Provider Demographics
NPI:1154930444
Name:WOLFE, SAMUEL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 GILES RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3115
Mailing Address - Country:US
Mailing Address - Phone:208-703-3445
Mailing Address - Fax:
Practice Address - Street 1:301 S MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-4978
Practice Address - Country:US
Practice Address - Phone:540-951-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty