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General NPI Number Information
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NPI Number | 1053850909
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Entity Type | Organization
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Legal Business Name | WOLKEN DENTAL D D S P C
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 8888 LADUE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2056
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Country | US
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Telephone | 314-727-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 8888 LADUE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2056
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Country | US
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Telephone | 314-727-6676
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER WOLKEN
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Credential |
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Telephone | 314-727-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 2008014689
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License Number State | MO
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