Provider Demographics
NPI:1689067415
Name:WOLF, KRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WOLF
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 1:5005 ROCKSIDE RD STE 1225
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6809
Mailing Address - Country:US
Mailing Address - Phone:216-447-9830
Mailing Address - Fax:
Practice Address - Street 1:5005 ROCKSIDE RD STE 1225
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6809
Practice Address - Country:US
Practice Address - Phone:216-447-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0406861223G0001X
OH30.0253431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice