Provider Demographics
NPI:1417209479
Name:CINDY WOLT INC
Entity Type:Organization
Organization Name:CINDY WOLT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-966-0011
Mailing Address - Street 1:848 W. COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031
Mailing Address - Country:US
Mailing Address - Phone:740-966-0011
Mailing Address - Fax:
Practice Address - Street 1:848 WEST COSHOCTON STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031
Practice Address - Country:US
Practice Address - Phone:740-966-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2559477Medicaid