Provider Demographics
NPI:1902827041
Name:KAREN K. WOLF, DDS, INC.
Entity Type:Organization
Organization Name:KAREN K. WOLF, DDS, INC.
Other - Org Name:INTEGRATED PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-352-4784
Mailing Address - Street 1:203 20TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2017
Mailing Address - Country:US
Mailing Address - Phone:319-352-4784
Mailing Address - Fax:319-352-4782
Practice Address - Street 1:2727 1ST AVE SE STE 3
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4844
Practice Address - Country:US
Practice Address - Phone:319-365-6150
Practice Address - Fax:319-365-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty