Healthcare Provider Details

I. General information

NPI: 1154115939
Provider Name (Legal Business Name): WESLEY WOLF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 NIAGARA ST
BUFFALO NY
14213-1101
US

IV. Provider business mailing address

155 LAWN AVE
BUFFALO NY
14207-1816
US

V. Phone/Fax

Practice location:
  • Phone: 716-427-7000
  • Fax: 716-332-5040
Mailing address:
  • Phone: 716-875-2904
  • Fax: 716-875-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: