MEDICARE: DR. DWAYNE CARL WOLTERS D.D.S.

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	06789	VA

General Provider Information

NPI Number	:	1992850093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWAYNE CARL WOLTERS D.D.S.

Provider Business Mailing Address
First Line	:	2262 BLUE STONE HILL DR
Second Line	:	SUITE A.
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-3405
Country	:	US
Telephone Number	:	540-433-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2262 BLUE STONE HILL DR
Second Line	:	SUITE A.
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-3405
Country	:	US
Telephone Number	:	540-433-3080
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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