Provider Demographics
NPI:1760228423
Name:WOLF, ROBERT CHASE (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHASE
Last Name:WOLF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HUDSON OAKS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4709
Mailing Address - Country:US
Mailing Address - Phone:817-717-9653
Mailing Address - Fax:
Practice Address - Street 1:100 HUDSON OAKS DR STE 110
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-4709
Practice Address - Country:US
Practice Address - Phone:817-717-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist