Provider Demographics
NPI:1558835280
Name:WOLKOFF, ELI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:
Last Name:WOLKOFF
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 1:301 E ARMOUR BLVD APT 501
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1254
Mailing Address - Country:US
Mailing Address - Phone:201-274-4265
Mailing Address - Fax:
Practice Address - Street 1:411 NICHOLS RD STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2015
Practice Address - Country:US
Practice Address - Phone:816-531-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210103871223G0001X
KS617801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty