1356588701 NPI number — WALTER PFITZINGER, DDS, PC NO. 2

Table of content: (NPI 1356588701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356588701 NPI number — WALTER PFITZINGER, DDS, PC NO. 2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTER PFITZINGER, DDS, PC NO. 2
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356588701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 PRODO DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65109-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-893-3163
Provider Business Mailing Address Fax Number:
573-893-8629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 PRODO DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-893-3163
Provider Business Practice Location Address Fax Number:
573-893-8629
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PFITZINGER
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
877-394-9994

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  015466 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 2008006645 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com