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General NPI Number Information
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NPI Number | 1003824863
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD WOLOV DDS
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 81 SAINT JAMES CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4020
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Country | US
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Telephone | 617-901-1382
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Fax | 561-626-5505
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Provider Business Mailing Address
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Address Line | 81 SAINT JAMES CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4020
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Country | US
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Telephone | 617-901-1382
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Fax | 561-626-5505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12132
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 50 057131
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 12643
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License Number State | FL
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