Individual
KLAUS DETLEF WOLFRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22036
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22036
STATE LICENSE
CA
Enumeration date
09/04/2008
Last updated
09/04/2008
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