Individual
DR. JAKE BRADY WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1310 E PINE ST, SUITE B, DEMING, NM 88030-7003
(575) 544-9999
Mailing address
8201 GOLF COURSE RD NW, ALBUQUERQUE, NM 87120-5842
(505) 892-9010
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4108
NM
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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