Provider Demographics
NPI:1164622395
Name:WALTER R. PFITZINGER D.D.S,, P.C.
Entity Type:Organization
Organization Name:WALTER R. PFITZINGER D.D.S,, P.C.
Other - Org Name:MID MISSOURI DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-814-1694
Mailing Address - Street 1:1500 VANDIVER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3932
Mailing Address - Country:US
Mailing Address - Phone:573-814-1694
Mailing Address - Fax:573-814-2845
Practice Address - Street 1:1500 VANDIVER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3932
Practice Address - Country:US
Practice Address - Phone:573-814-1694
Practice Address - Fax:573-814-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0104351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty