Provider Demographics
NPI:1508595075
Name:WOLTER, KATIE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:WOLTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W FRYE RD APT 2014
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3215
Mailing Address - Country:US
Mailing Address - Phone:563-513-8147
Mailing Address - Fax:
Practice Address - Street 1:524 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6554
Practice Address - Country:US
Practice Address - Phone:602-276-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0119061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice