Provider Demographics
NPI:1477661973
Name:MAUST, WALTER ELTON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ELTON
Last Name:MAUST
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 1:41 BECK MILL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3833
Mailing Address - Country:US
Mailing Address - Phone:717-632-5202
Mailing Address - Fax:717-633-5948
Practice Address - Street 1:41 BECK MILL RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3833
Practice Address - Country:US
Practice Address - Phone:717-632-5202
Practice Address - Fax:717-633-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO16478L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12165858OtherSTATE EMPLOYER WITHHOLDIN