Provider Demographics
NPI:1992938674
Name:WOLFF, WILLIAM CHAD (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAD
Last Name:WOLFF
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 1:12346 W CARIBEE INLET DR
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5682
Mailing Address - Country:US
Mailing Address - Phone:208-559-0608
Mailing Address - Fax:
Practice Address - Street 1:5550 EAST FRANKLIN ROAD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7910
Practice Address - Country:US
Practice Address - Phone:201-461-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-42561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice