Provider Demographics
NPI:1174656342
Name:WOLF FAMILY DENTISTRY, PC.
Entity Type:Organization
Organization Name:WOLF FAMILY DENTISTRY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:OSTERMILLER
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-362-3730
Mailing Address - Street 1:3550 W JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8576
Mailing Address - Country:US
Mailing Address - Phone:219-362-3730
Mailing Address - Fax:219-324-4273
Practice Address - Street 1:3550 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8576
Practice Address - Country:US
Practice Address - Phone:219-362-3730
Practice Address - Fax:219-324-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty