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General NPI Number Information
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NPI Number | 1609037316
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Entity Type | Individual
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Provider Name | CHRISTINE ANNE WOHLFORD D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-719-2400
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Fax | 618-791-2408
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Provider Business Mailing Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-719-2400
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Fax | 618-791-2408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019028314
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.022815
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2015009835
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002438
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License Number State | IL
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