Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 13828 | TX |
NPI | 1295951465 |
---|---|
Provider Name | Dr. Melody Faye Wolf |
First Address | Houston, TX 77009-8310 |
Second Address | Houston, TX 77009-8310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 16/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007264702 | (05) | TX |