Provider Demographics
NPI:1467546887
Name:GOTWALD, DAVID KING III (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KING
Last Name:GOTWALD
Suffix:III
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 1:2 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2753
Mailing Address - Country:US
Mailing Address - Phone:812-254-3585
Mailing Address - Fax:812-254-3594
Practice Address - Street 1:2 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2753
Practice Address - Country:US
Practice Address - Phone:812-254-3585
Practice Address - Fax:812-254-3594
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist