Provider Demographics
NPI:1912395369
Name:LAWRENCE A. WOLFF, D.D.S., INC
Entity Type:Organization
Organization Name:LAWRENCE A. WOLFF, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-986-2994
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
Practice Address - Street 2:STE 209
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-986-2994
Practice Address - Fax:818-846-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty