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General NPI Number Information
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NPI Number | 1669527214
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Entity Type | Individual
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Provider Name | BARRY WOLFE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4405 STARKEY RD STE A
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City | ROANOKE
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State | VA
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Zip | 24018-0616
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Country | US
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Telephone | 540-772-2913
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Fax | 540-989-6623
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Provider Business Mailing Address
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Address Line | 3250 AVENHAM AVE SW
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City | ROANOKE
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State | VA
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Zip | 24014-1408
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Country | US
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Telephone | 540-985-0263
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 041004587
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License Number State | VA
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