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General NPI Number Information
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NPI Number | 1366253007
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Entity Type | Organization
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Legal Business Name | STEVEN WOLFRAM DENTAL CORPORATION
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 23731 EL TORO RD STE D
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City | LAKE FOREST
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State | CA
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Zip | 92630-8615
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Country | US
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Telephone | 949-787-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 23731 EL TORO RD STE D
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City | LAKE FOREST
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State | CA
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Zip | 92630-8615
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Country | US
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Telephone | 949-787-1733
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN WOLFRAM
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Credential |
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Telephone | 909-528-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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