Active NPI
Linda Wolf
- Pediatric Dentistry
- Kennesaw, GA
National Provider Identifier
1053464800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN008821
- Practice address
- 205 Hawkins Store Rd NW
Suite a-1
Kennesaw, GA 30144-6204 - Phone
- (770) 926-3400
- Fax
- (770) 926-6317
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN008821 | GA | Primary |
Addresses
Primary practice location
205 Hawkins Store Rd NW
Suite a-1
Kennesaw, GA 30144-6204
Mailing address
205 Hawkins Store Rd NW
Suite a-1
Kennesaw, GA 30144-6204
Phone (770) 926-3400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00157924B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN008821 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053464800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 HAWKINS STORE RD NW",
"address_2": "SUITE A-1",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301446204",
"telephone_number": "770-926-3400",
"fax_number": "770-926-6317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 HAWKINS STORE RD NW",
"address_2": "SUITE A-1",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301446204",
"telephone_number": "770-926-3400",
"fax_number": "770-926-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "LINDA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN008821",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00157924B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.