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General NPI Number Information
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NPI Number | 1366565384
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Entity Type | Organization
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Legal Business Name | DANIEL WOLTER DMD MS PC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 14940 W INDIAN SCHOOL ROAD SUITE 450
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City | GOODYEAR
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State | AZ
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Zip | 85338
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Country | US
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Telephone | 623-536-6789
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Fax | 623-536-6543
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Provider Business Mailing Address
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Address Line | 865 W ORCHARD LN
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-5076
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Country | US
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Telephone | 623-337-7542
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Fax | 623-792-8959
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Authorized Official
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Title or Position | PRESIDENT-DENTIST
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Name | DR. DANIEL WOLTER
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Credential | DMD MS
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Telephone | 623-536-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D6646
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License Number State | AZ
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