Provider Demographics
NPI:1356588701
Name:WALTER PFITZINGER, DDS, PC NO. 2
Entity type:Organization
Organization Name:WALTER PFITZINGER, DDS, PC NO. 2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PFITZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:877-394-9994
Mailing Address - Street 1:214 PRODO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-3904
Mailing Address - Country:US
Mailing Address - Phone:573-893-3163
Mailing Address - Fax:573-893-8629
Practice Address - Street 1:214 PRODO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-3904
Practice Address - Country:US
Practice Address - Phone:573-893-3163
Practice Address - Fax:573-893-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080066451223G0001X
MO0154661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty