MEDICARE: DR. GARY DAVID WOLFE III

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	12560	TN
2	390200000X	Student in an Organized Health Care Education/Training Program		NC

General Provider Information

NPI Number	:	1851079461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DAVID WOLFE III

Provider Business Mailing Address
First Line	:	1601 ABBEY PL STE 220
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3825
Country	:	US
Telephone Number	:	704-512-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 ABBEY PL STE 220
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3825
Country	:	US
Telephone Number	:	704-512-2110
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	04/20/2026

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