Provider Demographics
NPI:1992850093
Name:WOLTERS, DWAYNE CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:CARL
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 1:2262 BLUE STONE HILL DR
Mailing Address - Street 2:SUITE A.
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3405
Mailing Address - Country:US
Mailing Address - Phone:540-433-3080
Mailing Address - Fax:
Practice Address - Street 1:2262 BLUE STONE HILL DR
Practice Address - Street 2:SUITE A.
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3405
Practice Address - Country:US
Practice Address - Phone:540-433-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA067891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice