MEDICARE: DR. DOUGLAS ANDREW WOLFE DDS

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	30-21691	OH
2	1223G0001X	General Practice Dentistry	8909	NC
3	1223G0001X	General Practice Dentistry	18444	FL

General Provider Information

NPI Number	:	1821083296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ANDREW WOLFE DDS

Provider Business Mailing Address
First Line	:	609 COTTONFIELD CIR
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-9387
Country	:	US
Telephone Number	:	330-348-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 PROVIDENCE ROAD SOUTH
Second Line	:	SUITE 220
City	:	WAXHAW
State	:	NC
Zip	:	28173
Country	:	US
Telephone Number	:	704-373-6040
Fax Number	:	704-373-6041

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/01/2011

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