Healthcare Provider Details

I. General information

NPI: 1902827041
Provider Name (Legal Business Name): KAREN K. WOLF, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 1ST AVE SE STE 3
CEDAR RAPIDS IA
52402-4844
US

IV. Provider business mailing address

203 20TH ST NW
WAVERLY IA
50677-2017
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-6150
  • Fax: 319-365-1844
Mailing address:
  • Phone: 319-352-4784
  • Fax: 319-352-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number07945
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KAREN KAY WOLF
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 319-352-4784