Provider Demographics
NPI:1053147645
Name:WOLZ, MAKENZIE (DDS)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:WOLZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6374 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2818
Mailing Address - Country:US
Mailing Address - Phone:870-476-0886
Mailing Address - Fax:
Practice Address - Street 1:370 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3507
Practice Address - Country:US
Practice Address - Phone:707-867-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist