Provider Demographics
NPI:1245787860
Name:WOLFE PATT PROSTHODONTICS
Entity Type:Organization
Organization Name:WOLFE PATT PROSTHODONTICS
Other - Org Name:BROOKLYN DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-821-2188
Mailing Address - Street 1:108 S PORTLAND AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1531
Mailing Address - Country:US
Mailing Address - Phone:617-821-2188
Mailing Address - Fax:
Practice Address - Street 1:185 MONTAGUE ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3600
Practice Address - Country:US
Practice Address - Phone:617-821-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X
NY0549111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty