Provider Demographics
NPI:1649391582
Name:DOLESKI AND WOLFORD ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:DOLESKI AND WOLFORD ORTHODONTICS, P.C.
Other - Org Name:KENNETH A. DOLESKI, D.M.D., M.S. AND MARIAN S. WOLFORD, D.M.D., M.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-835-3888
Mailing Address - Street 1:3230 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4202
Mailing Address - Country:US
Mailing Address - Phone:814-835-3888
Mailing Address - Fax:814-835-0079
Practice Address - Street 1:3230 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4202
Practice Address - Country:US
Practice Address - Phone:814-835-3888
Practice Address - Fax:814-835-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027002L1223X0400X
PADS026417L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty