Provider Demographics
NPI:1518423623
Name:WOLTER ADVANCED DENTAL CARE, PC
Entity Type:Organization
Organization Name:WOLTER ADVANCED DENTAL CARE, PC
Other - Org Name:WOLTER ADVANCED DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-496-9093
Mailing Address - Street 1:20 PARKWOOD DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4400
Mailing Address - Country:US
Mailing Address - Phone:717-494-9088
Mailing Address - Fax:
Practice Address - Street 1:20 PARKWOOD DR.
Practice Address - Street 2:STE 3
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-496-9093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOLTER FAMILY DENTISTRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies