Provider Demographics
NPI:1609037316
Name:WOHLFORD, CHRISTINE ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANNE
Last Name:WOHLFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 COLUMBIA CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2561
Mailing Address - Country:US
Mailing Address - Phone:618-719-2400
Mailing Address - Fax:618-791-2408
Practice Address - Street 1:1320 COLUMBIA CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2561
Practice Address - Country:US
Practice Address - Phone:618-719-2400
Practice Address - Fax:618-791-2408
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028314122300000X
OH30.022815122300000X
MO20150098351223P0221X
IL0210024381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist