Healthcare Provider Details

I. General information

NPI: 1679140321
Provider Name (Legal Business Name): A WULFSOHN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W BELMONT AVE
CHICAGO IL
60657-3303
US

IV. Provider business mailing address

1014 W BELMONT AVE
CHICAGO IL
60657-3303
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-6322
  • Fax: 773-472-6321
Mailing address:
  • Phone: 773-573-6052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIELLE WULFSOHN
Title or Position: DENTIST
Credential: DMD
Phone: 773-573-6052