Provider Demographics
NPI:1295823763
Name:WOLTERS, SCOTT LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:WOLTERS
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 1:5221 WAYNETOWNE COURT
Mailing Address - Street 2:SUTIE B
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2124
Mailing Address - Country:US
Mailing Address - Phone:937-237-0360
Mailing Address - Fax:937-237-2707
Practice Address - Street 1:5221 WAYNETOWNE COURT
Practice Address - Street 2:SUTIE B
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2124
Practice Address - Country:US
Practice Address - Phone:937-237-0360
Practice Address - Fax:937-237-2707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice