Provider Demographics
NPI:1285921049
Name:WOLFE, ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WOLFE
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 1:16311 VENTURA BLVD STE 1296
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4378
Mailing Address - Country:US
Mailing Address - Phone:818-788-1231
Mailing Address - Fax:
Practice Address - Street 1:16311 VENTURA BLVD STE 1296
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4378
Practice Address - Country:US
Practice Address - Phone:818-788-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62256122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist