Provider Demographics
NPI:1679140321
Name:A WULFSOHN DMD PC
Entity type:Organization
Organization Name:A WULFSOHN DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WULFSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-573-6052
Mailing Address - Street 1:1014 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3303
Mailing Address - Country:US
Mailing Address - Phone:773-573-6052
Mailing Address - Fax:
Practice Address - Street 1:1014 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3303
Practice Address - Country:US
Practice Address - Phone:773-472-6322
Practice Address - Fax:773-472-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1871945246OtherDENTIST