Provider Demographics
NPI:1093884991
Name:WOLS, DANIEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:WOLS
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 1:9661 W 143RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2088
Mailing Address - Country:US
Mailing Address - Phone:708-464-1222
Mailing Address - Fax:708-403-8657
Practice Address - Street 1:9661 W 143RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2088
Practice Address - Country:US
Practice Address - Phone:708-464-1222
Practice Address - Fax:708-403-8657
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice