Provider Demographics
NPI:1619184413
Name:KALTZ, MITCHELL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:E
Last Name:KALTZ
Suffix:
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 1:209 RED MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-4412
Mailing Address - Country:US
Mailing Address - Phone:215-822-3137
Mailing Address - Fax:
Practice Address - Street 1:413 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4229
Practice Address - Country:US
Practice Address - Phone:610-272-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025559-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice