Healthcare Provider Details

I. General information

NPI: 1326490293
Provider Name (Legal Business Name): ALLISON WOLF DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114
US

IV. Provider business mailing address

3272 SALT CREEK CIR
LINCOLN NE
68504-4759
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6100
  • Fax:
Mailing address:
  • Phone: 402-660-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7322
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: