Provider Demographics
NPI:1356172688
Name:WOLFF, LAURA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 S 30TH ST APT F139
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-3238
Mailing Address - Country:US
Mailing Address - Phone:650-417-1709
Mailing Address - Fax:
Practice Address - Street 1:22205 MERIDIAN E STE 109
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9781
Practice Address - Country:US
Practice Address - Phone:650-417-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615724071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice