Provider Demographics
NPI:1902521263
Name:WALTER FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:WALTER FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-242-9550
Mailing Address - Street 1:1 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5442
Mailing Address - Country:US
Mailing Address - Phone:304-242-9550
Mailing Address - Fax:
Practice Address - Street 1:1 PARK VIEW LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5442
Practice Address - Country:US
Practice Address - Phone:304-242-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty