Provider Demographics
NPI:1821190869
Name:WOLF, TONI ELLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:ELLIS
Last Name:WOLF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 OLD ORCHARD PROFESSIONAL BUILDING
Mailing Address - Street 2:SUITE 232
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1412
Mailing Address - Country:US
Mailing Address - Phone:847-673-2052
Mailing Address - Fax:847-673-5002
Practice Address - Street 1:64 OLD ORCHARD PROFESSIONAL BUILDING
Practice Address - Street 2:SUITE 232
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1412
Practice Address - Country:US
Practice Address - Phone:847-673-2052
Practice Address - Fax:847-673-5002
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice