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General NPI Number Information
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NPI Number | 1154742476
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Entity Type | Organization
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Legal Business Name | DR. ELIZABETH WOLFE, DDS DENTAL GROUP
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Dates
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Enumeration Date | 01/05/2014
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Last Update Date | 01/05/2014
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD SUITE 1035
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone | 626-390-0798
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 VENTURA BLVD SUITE 1035
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ELIZABETH WOLFE
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Credential | DDS
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Telephone | 626-390-0798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62256
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License Number State | CA
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