Provider Demographics
NPI:1225104755
Name:MALTZ, DAVID OLIVER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:OLIVER
Last Name:MALTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2205
Mailing Address - Country:US
Mailing Address - Phone:610-667-3631
Mailing Address - Fax:610-667-4504
Practice Address - Street 1:113 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2205
Practice Address - Country:US
Practice Address - Phone:610-667-3631
Practice Address - Fax:610-667-4504
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022365L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice