Provider Demographics
NPI:1700032158
Name:WOLTER, DANIEL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WOLTER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 W INDIAN SCHOOL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7308
Mailing Address - Country:US
Mailing Address - Phone:623-536-6789
Mailing Address - Fax:623-536-6543
Practice Address - Street 1:14940 W INDIAN SCHOOL RD STE 450
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7308
Practice Address - Country:US
Practice Address - Phone:623-536-6789
Practice Address - Fax:623-536-6543
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice