Provider Demographics
NPI:1982609152
Name:WOLF, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 GENERAL GEORGE PATTON RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2596
Mailing Address - Country:US
Mailing Address - Phone:615-308-1276
Mailing Address - Fax:
Practice Address - Street 1:7633 HIGHWAY 70 S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1706
Practice Address - Country:US
Practice Address - Phone:615-646-2655
Practice Address - Fax:615-646-2615
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0030891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice