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General NPI Number Information
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NPI Number | 1801263272
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Entity Type | Organization
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Legal Business Name | WOLF AND OSBORNE, LTD
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 1353 E MOUND RD
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City | DECATUR
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State | IL
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Zip | 62526-9345
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Country | US
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Telephone | 217-875-7600
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Fax | 217-875-7681
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Provider Business Mailing Address
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Address Line | 1353 E MOUND RD STE 101
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City | DECATUR
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State | IL
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Zip | 62526-3600
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Country | US
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Telephone | 217-875-7600
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Fax | 217-875-7681
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Authorized Official
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Title or Position | PRESIDENT/GENERAL DENTIST
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Name | DR. KEVIN THOMAS WOLF
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Credential |
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Telephone | 217-875-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019018111
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License Number State | IL
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