Provider Demographics
NPI:1891221248
Name:WOLTERS, ADAM SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SCOTT
Last Name:WOLTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 RED CEDAR ST BLDG 400
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8906
Mailing Address - Country:US
Mailing Address - Phone:843-815-6500
Mailing Address - Fax:
Practice Address - Street 1:347 RED CEDAR ST BLDG 400
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8906
Practice Address - Country:US
Practice Address - Phone:843-815-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025065122300000X
SCDGD.10311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1316036676Medicaid