Provider Demographics
NPI:1669527214
Name:WOLFE, BARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 AVENHAM AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1408
Mailing Address - Country:US
Mailing Address - Phone:540-985-0263
Mailing Address - Fax:
Practice Address - Street 1:4405 STARKEY RD STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0616
Practice Address - Country:US
Practice Address - Phone:540-772-2913
Practice Address - Fax:540-989-6623
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0410045871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA077257OtherBLUE CROSS CLUE SHIELD
VA077257OtherBLUE CROSS CLUE SHIELD