Provider Demographics
NPI:1942553060
Name:ALAN WOLKOFF D,M.D.
Entity Type:Organization
Organization Name:ALAN WOLKOFF D,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-753-2274
Mailing Address - Street 1:93 WEDGEWOOD DR
Mailing Address - Street 2:P,O,BOX 3066
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3611
Mailing Address - Country:US
Mailing Address - Phone:203-753-2274
Mailing Address - Fax:203-597-8656
Practice Address - Street 1:93 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3611
Practice Address - Country:US
Practice Address - Phone:203-753-2274
Practice Address - Fax:203-597-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002053890Medicaid