Provider Demographics
NPI:1558423590
Name:WOHLFELD, MARK ELLIOT (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ELLIOT
Last Name:WOHLFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHATEAU PLACE
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506
Mailing Address - Country:US
Mailing Address - Phone:585-624-4237
Mailing Address - Fax:
Practice Address - Street 1:325 WEST STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-394-4058
Practice Address - Fax:585-394-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00788358Medicaid
NYAW9516610OtherDEA