=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619185444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLINGTON DENTAL OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12783 W FOREST HILL BLVD SUITE J
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-793-5549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12783 W FOREST HILL BLVD SUITE J
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-793-5549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFREY H WOLFF
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 561-793-5549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN6519
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------