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General NPI Number Information
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NPI Number | 1023239068
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Entity Type | Organization
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Legal Business Name | LLOYD B. WOLFE, JR., D.M.D.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 406 BRIARWOOD DR STE 102
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City | JACKSON
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State | MS
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Zip | 39206-3059
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Country | US
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Telephone | 601-957-9200
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Fax | 601-957-2060
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Provider Business Mailing Address
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Address Line | 406 BRIARWOOD DR STE 102
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City | JACKSON
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State | MS
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Zip | 39206-3059
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Country | US
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Telephone | 601-957-9200
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Fax | 601-957-2060
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. LLOYD B. WOLFE JR.
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Credential | D.M.D.
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Telephone | 601-957-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 210884
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License Number State | MS
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