Provider Demographics
NPI:1871265595
Name:WOLTER ADVANCED DENTAL CARE, PC
Entity Type:Organization
Organization Name:WOLTER ADVANCED DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
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:717-496-9093
Mailing Address - Fax:717-660-2982
Practice Address - Street 1:20 PARKWOOD DR STE 3
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4400
Practice Address - Country:US
Practice Address - Phone:717-496-9093
Practice Address - Fax:717-660-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty