Provider Demographics
NPI:1497967822
Name:KENNETH J. WOLNIK, DDS INC
Entity Type:Organization
Organization Name:KENNETH J. WOLNIK, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLNIK
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-888-5055
Mailing Address - Street 1:6363 YORK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3031
Mailing Address - Country:US
Mailing Address - Phone:440-888-5055
Mailing Address - Fax:440-888-0249
Practice Address - Street 1:6363 YORK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3031
Practice Address - Country:US
Practice Address - Phone:440-888-5055
Practice Address - Fax:440-888-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH216921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty