Individual
DR. ROBERT OWEN WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
107 S PROSPECT RD, BLOOMINGTON, IL 61704-4403
(309) 663-0433
Mailing address
700 N LARRABEE ST, #115, CHICAGO, IL 60654-7014
(216) 973-0552
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028496
IL
1223G0001X
General Practice Dentistry
30-019566
OH
Other
Enumeration date
11/20/2006
Last updated
01/26/2015
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