Healthcare Provider Details

I. General information

NPI: 1699600296
Provider Name (Legal Business Name): WOOLF DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N VAL VISTA DR STE 104
MESA AZ
85213-8609
US

IV. Provider business mailing address

342 N VAL VISTA DR STE 104
MESA AZ
85213-8609
US

V. Phone/Fax

Practice location:
  • Phone: 480-734-2080
  • Fax:
Mailing address:
  • Phone: 480-734-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DALLAS WOOLF
Title or Position: OWNER
Credential: DDS
Phone: 480-734-2080