Individual
KEVIN THOMAS WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1353 E MOUND RD STE 101, DECATUR, IL 62526-3600
(217) 875-7600
Mailing address
1353 E MOUND RD STE 101, DECATUR, IL 62526-3600
(217) 875-7600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.031678
IL
1223G0001X
General Practice Dentistry
Primary
019.031678
IL
Other
Enumeration date
06/08/2018
Last updated
12/28/2022
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