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General NPI Number Information
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NPI Number | 1770588972
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Entity Type | Individual
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Provider Name | WALTER ROBERT PFITZINGER D.D.S, M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1500 VANDIVER DR STE 104
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City | COLUMBIA
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State | MO
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Zip | 65202-3932
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Country | US
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Telephone | 573-814-1694
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Fax | 573-814-2845
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Provider Business Mailing Address
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Address Line | 12 WESTBURY DR STE D
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2543
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Country | US
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Telephone | 636-925-2787
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Fax | 636-925-2829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10435
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 10435
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10435
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License Number State | MO
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