Provider Demographics
NPI:1851412159
Name:WOLTERMAN, RICHARD J (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:WOLTERMAN
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 1:1163 FEHL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4349
Mailing Address - Country:US
Mailing Address - Phone:513-231-0041
Mailing Address - Fax:513-231-9675
Practice Address - Street 1:1163 FEHL LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4349
Practice Address - Country:US
Practice Address - Phone:513-231-0041
Practice Address - Fax:513-231-9675
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics