Healthcare Provider Details

I. General information

NPI: 1982095808
Provider Name (Legal Business Name): CINDY WOLT DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 WEST COSHOCTON STREET
JOHNSTOWN OH
43031
US

IV. Provider business mailing address

848 WEST COSHOCTON STREET
JOHNSTOWN OH
43031
US

V. Phone/Fax

Practice location:
  • Phone: 740-966-0011
  • Fax: 740-966-5556
Mailing address:
  • Phone: 740-966-0011
  • Fax: 740-966-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY WOLT
Title or Position: OWNER
Credential: DDS
Phone: 740-966-0011