Provider Demographics
NPI:1154334530
Name:WOLKSTEIN, PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:WOLKSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:841 BLOSSOM HILL RD STE 210
Mailing Address - Street 2:SAN JOSE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2704
Mailing Address - Country:US
Mailing Address - Phone:408-578-6550
Mailing Address - Fax:408-226-3182
Practice Address - Street 1:841 BLOSSOM HILL RD STE 210
Practice Address - Street 2:SAN JOSE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-578-6550
Practice Address - Fax:408-226-3182
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA235771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry