Robert Owen Wolf, DDS

Dentist · Bloomington, IL

Individual Active NPI

NPI number 1962576967

Practice location

107 S Prospect Rd
Bloomington, IL 61704-4403
Phone
(309) 663-0433

Open in Google Maps

NPI record

NPI
1962576967
Entity type
Individual (Type 1)
Enumeration date
November 20, 2006
Last updated
January 26, 2015
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X 019.028496 IL
General Practice Dentistry 1223G0001X 30-019566 OH

Mailing address

700 N Larrabee St
#115
Chicago, IL 60654-7014
Phone
(216) 973-0552

About Dr. Wolf

Robert Owen Wolf, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 107 S Prospect Rd, Bloomington, IL 61704-4403. The NPI number 1962576967 was assigned on November 20, 2006 and the record was last updated on January 26, 2015.

Dr. Wolf lists 2 licenses in the registry: #019.028496 (IL) for Dentist; #30-019566 (OH) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Robert Owen Wolf, DDS?

The NPI number is 1962576967.

What is the phone number of Dr. Wolf?

The phone number listed for the practice location is (309) 663-0433.

Where is Dr. Wolf located?

107 S Prospect Rd, Bloomington, IL 61704-4403.

What is the taxonomy code for Dr. Wolf?

The primary taxonomy code is 122300000X – Dentist; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

Other Dentist providers in Bloomington

All Dentist providers in Bloomington, IL →