MEDICARE: DR. JASON F WOLVEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	47823	CA

General Provider Information

NPI Number	:	1013185990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON F WOLVEN D.D.S.

Provider Business Mailing Address
First Line	:	831 HARRIS ST
Second Line	:	SUITE B
City	:	EUREKA
State	:	CA
Zip	:	95503-4541
Country	:	US
Telephone Number	:	707-445-1301
Fax Number	:	707-445-0151

Provider Business Practice Location Address
First Line	:	831 HARRIS ST
Second Line	:	SUITE B
City	:	EUREKA
State	:	CA
Zip	:	95503-4541
Country	:	US
Telephone Number	:	707-445-1301
Fax Number	:	707-445-0151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	09/29/2009

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