Provider Demographics
NPI:1508595075
Name:WOLTER, KATIE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:WOLTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 NEWTON RD APT 7
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2257
Mailing Address - Country:US
Mailing Address - Phone:563-513-8147
Mailing Address - Fax:
Practice Address - Street 1:2600 CORNHUSKER DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3905
Practice Address - Country:US
Practice Address - Phone:402-494-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3902000000X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice