Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 28262 | CA |
NPI | 1114947108 |
---|---|
Provider Name | Dr. David J. Wolfe |
First Address | San Bernardino, CA 92408-3465 |
Second Address | San Bernardino, CA 92408-3465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |