NPIMap

Individual provider Active NPI

Jake Brady Wolf, D.D.S.

  • Dentist
  • Deming, NM
National Provider Identifier
1346655974
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD4108 Issued in NM
Practice address
1310 E Pine St
Suite B
Deming, NM 88030-7003
Phone
(575) 544-9999
NPI assigned
Jun 23, 2014
Last updated
Jun 23, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD4108 NM Primary

Addresses

Primary practice location

1310 E Pine St
Suite B
Deming, NM 88030-7003

Mailing address

8201 Golf Course Rd NW
Albuquerque, NM 87120-5842
Phone (505) 892-9010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DD4108NMMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tasker Hatch Rowan LLC Past Accepting new patients
Southern New Mexico Orthodontics LLC Dentist Past Accepting new patients
Smiles for NM Kids Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1346655974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 GOLF COURSE RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871205842",
            "telephone_number": "505-892-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E PINE ST",
            "address_2": "SUITE B",
            "city": "DEMING",
            "state": "NM",
            "postal_code": "880307003",
            "telephone_number": "575-544-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "JAKE",
        "middle_name": "BRADY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deming, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.