Provider Demographics
NPI:1144675273
Name:KRISTINA M. WOLF, DMD, PC
Entity type:Organization
Organization Name:KRISTINA M. WOLF, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-223-0072
Mailing Address - Street 1:100 HOSTETLER RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3111
Mailing Address - Country:US
Mailing Address - Phone:814-266-9773
Mailing Address - Fax:
Practice Address - Street 1:100 HOSTETLER RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3111
Practice Address - Country:US
Practice Address - Phone:814-266-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0406861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty