Provider Demographics
NPI:1497832968
Name:WOLFE, PATRICK LYN (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYN
Last Name:WOLFE
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 1:1016 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2490
Mailing Address - Country:US
Mailing Address - Phone:515-957-8396
Mailing Address - Fax:
Practice Address - Street 1:125 24TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2167
Practice Address - Country:US
Practice Address - Phone:515-967-9790
Practice Address - Fax:515-967-1425
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0481630Medicaid