Provider Demographics
NPI:1659107605
Name:WOLFE, ALEXANDRA (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 PACIFIC ST APT 253
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7367
Mailing Address - Country:US
Mailing Address - Phone:716-799-9546
Mailing Address - Fax:
Practice Address - Street 1:5 BROOK ST
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4549
Practice Address - Country:US
Practice Address - Phone:203-655-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist