Provider Demographics
NPI:1730275512
Name:WOOLF, MICHAEL T (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:WOOLF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 N VAN NESS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-7169
Mailing Address - Country:US
Mailing Address - Phone:559-229-8460
Mailing Address - Fax:559-229-6776
Practice Address - Street 1:7031 N VAN NESS BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7169
Practice Address - Country:US
Practice Address - Phone:559-229-8460
Practice Address - Fax:559-229-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice