Provider Demographics
NPI:1275524787
Name:WALTZ, ROBERT LEWIS JR (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:WALTZ
Suffix:JR
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 1:2210 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2852
Mailing Address - Country:US
Mailing Address - Phone:717-755-9695
Mailing Address - Fax:717-757-2274
Practice Address - Street 1:2210 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2852
Practice Address - Country:US
Practice Address - Phone:717-755-9695
Practice Address - Fax:717-757-2274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023711L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BW0927650OtherDEA