Healthcare Provider Details

I. General information

NPI: 1386867802
Provider Name (Legal Business Name): STEVE L WOLF DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23895 NOVI RD SUITE 200
NOVI MI
48375-0201
US

IV. Provider business mailing address

23895 NOVI RD SUITE 200
NOVI MI
48375-0201
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. STEVE L WOLF
Title or Position: PRESIDENT
Credential: DDS
Phone: 248-380-8020