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General NPI Number Information
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NPI Number | 1730597709
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Entity Type | Individual
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Provider Name | BRANDON WOLF D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 16506 POINTE VILLAGE DR. SUITE 101
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City | TAMPA
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State | FL
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Zip | 33647
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Country | US
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Telephone | 813-906-5668
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Fax |
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Provider Business Mailing Address
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Address Line | 613 LEGION DR
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City | DESTIN
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State | FL
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Zip | 32541-2415
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Country | US
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Telephone | 330-502-7292
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D.007302-C
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039738
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8352
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28661.
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28661
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License Number State | FL
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