Provider Demographics
NPI:1801841101
Name:WOLANIN, ALFRED JOHN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOHN
Last Name:WOLANIN
Suffix:JR
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 1:2010 W CHESTER PIKE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2700
Mailing Address - Country:US
Mailing Address - Phone:610-449-2100
Mailing Address - Fax:610-449-9415
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:SUITE 128
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2700
Practice Address - Country:US
Practice Address - Phone:610-449-2100
Practice Address - Fax:610-449-9415
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS - 019953-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29568Medicare UPIN
PA144546QPRMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #