Provider Demographics
NPI:1023266483
Name:WOLFE, PATRICK LEE (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEE
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CRESTVIEW DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9516
Mailing Address - Country:US
Mailing Address - Phone:715-381-5556
Mailing Address - Fax:
Practice Address - Street 1:900 CRESTVIEW DR
Practice Address - Street 2:SUITE 240
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9516
Practice Address - Country:US
Practice Address - Phone:715-381-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4584-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33723000Medicaid