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General NPI Number Information
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NPI Number | 1952606733
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Entity Type | Organization
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Legal Business Name | GONSALVES AND WOLFF, DDS II
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 982 LEE ANN DR NE
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City | CONCORD
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State | NC
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Zip | 28025-2957
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Country | US
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Telephone | 704-749-4141
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Fax | 704-871-1505
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Provider Business Mailing Address
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Address Line | 1424A FERN CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-9376
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Country | US
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Telephone | 704-749-4141
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Fax | 704-871-1505
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. SHAWN N WOLFF
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Credential | DDS
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Telephone | 704-749-4141
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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 | 8456
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License Number State | NC
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