Spirit Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

014616 Issued in MO

Legal business name

SPIRIT DENTAL, LLC

Practice address

109 Long Rd
Chesterfield, MO 63005

Phone

(636) 530-7260

Fax

(636) 733-9084

NPI assigned

Jun 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack E. Wolf, D.M.D.NPI 1154484335

Title

Owner

Phone

(636) 530-7260

Specialties & licenses 1

Addresses

Other names 1

• Jack E. Wolf D.M.D. Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Edwin Wolf, DMD

  • General Practice Dentistry
  • Chesterfield, MO
  • NPI 1154484335
  NPD (past) Authorized official

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251158400000",
    "number": "1710182183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 LONG RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "63005",
            "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": "109 LONG RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "63005",
            "telephone_number": "636-530-7260",
            "fax_number": "636-733-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRIT DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2009-08-25",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-530-7260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "014616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jack E. Wolf D.M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 25, 2009; 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.