Provider Demographics
NPI:1306038922
Name:WOLF, ROBERT BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:WOLF
Suffix:
Gender:M
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-394-1670
Mailing Address - Fax:609-895-1166
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:SUITE 1A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-394-1670
Practice Address - Fax:609-895-1166
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJDI0120541223P0700X
NJ1223P0700X1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI012054OtherLICENSE