Healthcare Provider Details

I. General information

NPI: 1336280684
Provider Name (Legal Business Name): LAWRENCE WOLFF DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16550 VENTURA BLVD STE. 209
ENCINO CA
91436-2004
US

IV. Provider business mailing address

PO BOX 1429
BURBANK CA
91507-1429
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-2994
  • Fax: 818-986-2559
Mailing address:
  • Phone: 818-986-2994
  • Fax: 818-986-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number32235
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE ALAN WOLFF
Title or Position: OWNER
Credential: DDS
Phone: 818-986-2994