Healthcare Provider Details

I. General information

NPI: 1295951465
Provider Name (Legal Business Name): MELODY FAYE WOLF DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 N MAIN ST
HOUSTON TX
77009-8310
US

IV. Provider business mailing address

1809 N MAIN ST
HOUSTON TX
77009-8310
US

V. Phone/Fax

Practice location:
  • Phone: 713-547-8076
  • Fax:
Mailing address:
  • Phone: 713-547-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number13828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: