Ellen Paulisick Wolf, D.D.S, FAGD

Primary specialty

DentistTaxonomy code 122300000X

License

9462 Issued in SC

Practice address

405 Faison Road
Suite 103
Mt Pleasant, SC 29466

Phone

(843) 654-1373

NPI assigned

Sep 13, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longboard Dental LLC

  • Dental Clinic/Center
  • Mt Pleasant, SC
  • NPI 1134837503
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1407138795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 FAISON RD STE 103",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294669527",
            "telephone_number": "843-654-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 FAISON ROAD",
            "address_2": "SUITE 103",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29466",
            "telephone_number": "843-654-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "ELLEN",
        "middle_name": "PAULISICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S, FAGD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-13",
        "last_updated": "2023-06-21",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "15171",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "9462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parker Andrew Wishneff, D.C.
• Ann Kirby Witherspoon, PT
• Elizabeth J Wofford, PHD, LPC
• Sondra Wojewodka, RPH
• Amie Diana Wolf, PHD
• Won of One Wigs
• Julie R Wood, ED.S., LPES
• Shaylyn Wood, CNM
• Chanda Woodard
• Sarah Woodman, LPC

• Dentist in Mt Pleasant, SC
• Providers in Mt Pleasant, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.