Provider Demographics
NPI:1154526648
Name:DRS WALZER SULLIVAN & HLOUSEK PA
Entity type:Organization
Organization Name:DRS WALZER SULLIVAN & HLOUSEK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUBOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HLOUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:410-268-7790
Mailing Address - Street 1:275 WEST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-268-7790
Mailing Address - Fax:410-268-7874
Practice Address - Street 1:275 WEST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-268-7790
Practice Address - Fax:410-268-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD321LMedicare PIN