Individual
DR. IVAN H. WOLTHUIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1524 LONG ST, SWEET HOME, OR 97386-2313
(541) 367-2931
(541) 367-2935
Mailing address
1524 LONG ST, SWEET HOME, OR 97386-2313
(541) 367-2931
(541) 367-2935
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7611
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233348
OMAP IDENTIFIER
OR
Enumeration date
11/04/2005
Last updated
07/08/2007
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