Provider Demographics
NPI:1629051057
Name:WALTERS, TERESE MARIE (DMD)
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:MARIE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:8212 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9449
Mailing Address - Country:US
Mailing Address - Phone:843-364-7350
Mailing Address - Fax:
Practice Address - Street 1:1001 W WILLIAMS ST STE 105
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3978
Practice Address - Country:US
Practice Address - Phone:919-362-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86491223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice