Provider Demographics
NPI:1831825702
Name:WOLSKI DENTAL GROUP PC
Entity type:Organization
Organization Name:WOLSKI DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-740-3878
Mailing Address - Street 1:4N541 CRANE LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-4762
Mailing Address - Country:US
Mailing Address - Phone:701-740-3878
Mailing Address - Fax:
Practice Address - Street 1:420 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2206
Practice Address - Country:US
Practice Address - Phone:815-570-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental