Provider Demographics
NPI:1578660353
Name:WOLSKE, EDWIN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:WILLIAM
Last Name:WOLSKE
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 1:140 GREGORY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3399
Mailing Address - Country:US
Mailing Address - Phone:925-685-8587
Mailing Address - Fax:925-685-7009
Practice Address - Street 1:140 GREGORY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3399
Practice Address - Country:US
Practice Address - Phone:925-685-8587
Practice Address - Fax:925-685-7009
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice