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General NPI Number Information
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NPI Number | 1659441103
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Entity Type | Individual
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Provider Name | MARK R. WOLF DDS
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 533 W NORTH AVE. SUITE 200
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City | ELMHURST
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State | IL
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Zip | 60126-2100
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Country | US
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Telephone | 630-941-3400
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Fax | 360-941-3421
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Provider Business Mailing Address
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Address Line | 533 W NORTH AVE. SUITE 200
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City | ELMHURST
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State | IL
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Zip | 60126-2100
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Country | US
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Telephone | 630-941-3400
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Fax | 360-941-3421
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019-015297
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021.000989
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019.015297
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License Number State | IL
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