MEDICARE: DR. RICHARD HOWARD WOLFF DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	030309	NY

General Provider Information

NPI Number	:	1679577928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD HOWARD WOLFF DDS

Provider Business Mailing Address
First Line	:	110 BRICK CHURCH RD
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-2036
Country	:	US
Telephone Number	:	845-354-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BRICK CHURCH RD
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-2036
Country	:	US
Telephone Number	:	845-354-8855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/08/2010

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