Healthcare Provider Details

I. General information

NPI: 1629070958
Provider Name (Legal Business Name): STEVE LAWRENCE WOLF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23895 NOVI RD STE 200
NOVI MI
48375-0200
US

IV. Provider business mailing address

23895 NOVI RD STE 200
NOVI MI
48375-0200
US

V. Phone/Fax

Practice location:
  • Phone: 248-380-8020
  • Fax: 248-380-7905
Mailing address:
  • Phone: 248-380-8020
  • Fax: 248-380-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901015916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: