Provider Demographics
NPI:1740335256
Name:WOLFF, LAWRENCE ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:WOLFF
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:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91507-1429
Mailing Address - Country:US
Mailing Address - Phone:818-986-2994
Mailing Address - Fax:818-846-6197
Practice Address - Street 1:16550 VENTURA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2086
Practice Address - Country:US
Practice Address - Phone:818-986-2994
Practice Address - Fax:818-986-2559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD32235Medicare PIN
CAU60799Medicare UPIN