Provider Demographics
NPI:1699899336
Name:JOHN B. DEWOLF, III, D.M.D., S.C.
Entity type:Organization
Organization Name:JOHN B. DEWOLF, III, D.M.D., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWOLF
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:715-823-2233
Mailing Address - Street 1:112 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1631
Mailing Address - Country:US
Mailing Address - Phone:715-823-2233
Mailing Address - Fax:715-823-5720
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1631
Practice Address - Country:US
Practice Address - Phone:715-823-2233
Practice Address - Fax:715-823-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty