Healthcare Provider Details

I. General information

NPI: 1821078981
Provider Name (Legal Business Name): ERWIN H WOLF II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 BERKSHIRE BLVD SUITE 800
WYOMISSING PA
19610
US

IV. Provider business mailing address

1075 BERKSHIRE BLVD SUITE 800
WYOMISSING PA
19610
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4093
  • Fax: 610-375-6454
Mailing address:
  • Phone: 610-374-4093
  • Fax: 610-375-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS017170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: