MEDICARE: DR. MARK LEWIS WALTZER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DI 01380900	NJ

General Provider Information

NPI Number	:	1891795761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LEWIS WALTZER D.M.D.

Provider Business Mailing Address
First Line	:	1930 MARLTON PIKE E
Second Line	:	SUITE X-114
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-4214
Country	:	US
Telephone Number	:	856-429-6412
Fax Number	:	856-429-6341

Provider Business Practice Location Address
First Line	:	1930 MARLTON PIKE E
Second Line	:	SUITE X-114
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-4214
Country	:	US
Telephone Number	:	856-429-6412
Fax Number	:	856-429-6341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/16/2016

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