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NPI Code Detail

MEDICARE: RICHARD EVAN WOLFERT D.M.D.

MEDICARE:   RICHARD EVAN WOLFERT  D.M.D.
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
11223G0001XGeneral Practice Dentistry14972MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014972OTHERMADELTA PROVIDER NUMBER

General Provider Information

NPI Number : 1033192281
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD EVAN WOLFERT D.M.D.
Provider Business Mailing Address
First Line : 9 DALEY RD
Second Line :
City : HINGHAM
State : MA
Zip : 02043-1201
Country : US
Telephone Number : 781-749-4151
Fax Number :
Provider Business Practice Location Address
First Line : 1121 MAIN ST
Second Line : SUITE #2
City : SOUTH WEYMOUTH
State : MA
Zip : 02190-1513
Country : US
Telephone Number : 781-335-0604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 07/08/2007

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