Diane L Wolter, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9770 Issued in MN

Practice address

11441 Osage St NW
Coon Rapids, MN 55433-3677

Phone

(763) 757-6600

Fax

(763) 757-3693

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982765905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11441 OSAGE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333677",
            "telephone_number": "763-757-6600",
            "fax_number": "763-757-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11441 OSAGE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333677",
            "telephone_number": "763-757-6600",
            "fax_number": "763-757-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTER",
        "first_name": "DIANE",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne T Witterholt, MD
• Alyssa Rose Wojciechowski, MD
• Christina Marie Wolf, DPT
• Julie Ann Wolfgram, NP-C
• Shawn E Wolk, CRNA
• Andrea Workman
• Shewangizaw Worku, M.D., PHD
• Andrew J Woychek, CRNA
• Kenyari Wright, LICSW
• Jack Wu

• General Practice Dentistry in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.