Provider Demographics
NPI:1144056409
Name:WALTER P VICKERS JR. DMD PC
Entity type:Organization
Organization Name:WALTER P VICKERS JR. DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-342-0380
Mailing Address - Street 1:1200 MONTLIMAR DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1711
Mailing Address - Country:US
Mailing Address - Phone:251-342-0380
Mailing Address - Fax:
Practice Address - Street 1:1200 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1711
Practice Address - Country:US
Practice Address - Phone:251-342-0380
Practice Address - Fax:251-344-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty