1366565384 NPI number — DANIEL WOLTER DMD MS PC

Table of content: (NPI 1366565384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366565384 NPI number — DANIEL WOLTER DMD MS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL WOLTER DMD MS PC
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:
1366565384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 W ORCHARD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITCHFIELD PARK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85340-5076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-337-7542
Provider Business Mailing Address Fax Number:
623-792-8959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14940 W INDIAN SCHOOL ROAD
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-536-6789
Provider Business Practice Location Address Fax Number:
623-536-6543
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLTER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-DENTIST
Authorized Official Telephone Number:
623-536-6789

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D6646 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com