Provider Demographics
NPI:1649224346
Name:WOLPERT, FRED J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:J
Last Name:WOLPERT
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 1:121 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2420
Mailing Address - Country:US
Mailing Address - Phone:518-587-8225
Mailing Address - Fax:518-587-8244
Practice Address - Street 1:121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2420
Practice Address - Country:US
Practice Address - Phone:518-587-8225
Practice Address - Fax:518-587-8244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice