Jack Edwin Wolf, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN14616 Issued in MO

Practice address

139 Long Rd
Chesterfield, MO 63005-1223

Phone

(636) 530-7260

Fax

(636) 733-9084

NPI assigned

Dec 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spirit Dental, LLC

  • General Practice Dentistry
  • Chesterfield, MO
  • NPI 1710182183
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1154484335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 LONG RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051223",
            "telephone_number": "636-530-7260",
            "fax_number": "636-733-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 LONG RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051223",
            "telephone_number": "636-530-7260",
            "fax_number": "636-733-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "JACK",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "DEN14616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlena Faye Wisnasky
• Donna J Witsberger, CRNA
• Bruce H Witte, M.D.
• Daniella L Wohlfarth, SLP
• Christopher J Wolf, DO
• Carolynn F Wolff, DMD
• Women'S Care of St Luke'S, LLC
• Women'S Health Care, Inc.
• Luu Thi Wong, OT
• Alexander Fred Wood, PHARM.D.

• General Practice Dentistry in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.