Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 12132 | MA |
Y | 1223E0200X | Endodontist | 50 057131 | NY |
N | 1223E0200X | Endodontist | DN 12643 | FL |
NPI | 1003824863 |
---|---|
Provider Name | Dr. Michael Richard Wolov |
First Address | Palm Beach Gardens, FL 33418-4020 |
Second Address | Palm Beach Gardens, FL 33418-4020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 24/02/2014 |