Individual
TYLER ANDREW WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7678 COTTONWOOD DR, JENISON, MI 49428
(616) 457-4600
(616) 457-6021
Mailing address
7678 COTTONWOOD DR, JENISON, MI 49428
(616) 457-4600
(616) 457-6021
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901017916
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1367809
UNITED CONCORDIA
—
Enumeration date
11/02/2006
Last updated
07/08/2007
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