MEDICARE: DR. PHILIP HOWARD WOLFSON 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
1	1223G0001X	General Practice Dentistry	009976	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285630269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP HOWARD WOLFSON D.M.D.

Provider Business Mailing Address
First Line	:	776 SHREWSBURY AVE
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-747-7711
Fax Number	:	732-747-0782

Provider Business Practice Location Address
First Line	:	776 SHREWSBURY AVE
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-747-7711
Fax Number	:	732-747-0782

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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