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General NPI Number Information
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NPI Number | 1992850093
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Entity Type | Individual
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Provider Name | DWAYNE CARL WOLTERS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2262 BLUE STONE HILL DR SUITE A.
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City | HARRISONBURG
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State | VA
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Zip | 22801-3405
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Country | US
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Telephone | 540-433-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 2262 BLUE STONE HILL DR SUITE A.
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City | HARRISONBURG
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State | VA
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Zip | 22801-3405
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Country | US
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Telephone | 540-433-3080
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 06789
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License Number State | VA
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