Provider Demographics
NPI:1427939602
Name:ROBERT M WALTER, DDS, PLLC
Entity type:Organization
Organization Name:ROBERT M WALTER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-355-2797
Mailing Address - Street 1:3200 S MUSTANG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6196
Mailing Address - Country:US
Mailing Address - Phone:405-355-2797
Mailing Address - Fax:
Practice Address - Street 1:3200 S MUSTANG RD STE 100
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6196
Practice Address - Country:US
Practice Address - Phone:405-355-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental