Provider Demographics
NPI:1366253007
Name:STEVEN WOLFRAM DENTAL CORPORATION
Entity type:Organization
Organization Name:STEVEN WOLFRAM DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-528-8158
Mailing Address - Street 1:23731 EL TORO RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8615
Mailing Address - Country:US
Mailing Address - Phone:949-787-1733
Mailing Address - Fax:
Practice Address - Street 1:23731 EL TORO RD STE D
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8615
Practice Address - Country:US
Practice Address - Phone:949-787-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN WOLFRAM DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental