Provider Demographics
NPI:1578737524
Name:WALTER F. ZOLLER, D.M.D., P.A.
Entity Type:Organization
Organization Name:WALTER F. ZOLLER, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-223-6829
Mailing Address - Street 1:796 FLORENCIA CIRCLE
Mailing Address - Street 2:PORT ST. JOHN
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4965
Mailing Address - Country:US
Mailing Address - Phone:321-223-6829
Mailing Address - Fax:
Practice Address - Street 1:796 FLORENCIA CIRCLE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4965
Practice Address - Country:US
Practice Address - Phone:321-223-6829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8641261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental