Provider Demographics
NPI:1124209069
Name:CAROLYNN F WOLFF DMD PC
Entity Type:Organization
Organization Name:CAROLYNN F WOLFF DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-537-3600
Mailing Address - Street 1:16216 BAXTER RD
Mailing Address - Street 2:STE 215
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:636-537-3600
Mailing Address - Fax:636-537-0066
Practice Address - Street 1:16216 BAXTER RD
Practice Address - Street 2:STE 215
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:636-537-3600
Practice Address - Fax:636-537-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty