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General NPI Number Information
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NPI Number | 1245787860
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Entity Type | Organization
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Legal Business Name | WOLFE PATT PROSTHODONTICS
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 185 MONTAGUE ST 8TH FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11201-3600
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Country | US
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Telephone | 617-821-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 108 S PORTLAND AVE APT 1A
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City | BROOKLYN
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State | NY
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Zip | 11217-1531
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Country | US
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Telephone | 617-821-2188
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Fax |
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Authorized Official
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Title or Position | PROSTHODONTIST
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Name | DR. MARISA PATT
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Credential | DMD
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Telephone | 617-821-2188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 054911
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License Number State | NY
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