Provider Demographics
NPI:1548816598
Name:CHRIS WOLBERG DDS & ASSOCIATES
Entity type:Organization
Organization Name:CHRIS WOLBERG DDS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT-DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GUST
Authorized Official - Last Name:WOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-379-9375
Mailing Address - Street 1:11507 ALLECINGIE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4301
Mailing Address - Country:US
Mailing Address - Phone:804-379-9375
Mailing Address - Fax:804-379-3913
Practice Address - Street 1:11507 ALLECINGIE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4301
Practice Address - Country:US
Practice Address - Phone:804-379-9375
Practice Address - Fax:804-379-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty