Provider Demographics
NPI:1104929710
Name:WOLKEN DENTAL
Entity type:Organization
Organization Name:WOLKEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-727-6676
Mailing Address - Street 1:8888 LADUE RD.
Mailing Address - Street 2:STE. 200
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-727-6676
Mailing Address - Fax:314-721-0930
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:STE 200
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124
Practice Address - Country:US
Practice Address - Phone:314-727-6676
Practice Address - Fax:314-721-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0121191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty