# DR. TODD W. WALTERS P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760568307
- **Authorized official:** DR. TODD WAYNE WALTERS D.D.S. (PRESIDENT -OWNER)
- **Authorized official phone:** (574) 722-5313

## Contact information

- **Practice address:** 800 FULTON ST STE 4A, LOGANSPORT, IN 46947-1579
- **Practice address phone:** (574) 722-5313
- **Practice address fax:** (574) 753-3025
- **Mailing address:** 800 FULTON ST STE 4A, LOGANSPORT, IN 46947-1579
- **Mailing address phone:** (574) 722-5313
- **Mailing address fax:** (574) 753-3025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12008831 | IN | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 02/25/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100070910 | — | IN |