Provider Demographics
NPI:1073661104
Name:WOLFERSTETTER, ROLAND PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:PETER
Last Name:WOLFERSTETTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1567
Mailing Address - Country:US
Mailing Address - Phone:414-464-8600
Mailing Address - Fax:414-464-8603
Practice Address - Street 1:9235 W CAPITOL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1567
Practice Address - Country:US
Practice Address - Phone:414-464-8600
Practice Address - Fax:414-464-8603
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50020741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI333-72-700Medicaid