Organization
FAMILY DENTAL PRACTICE P.C. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM E. WALTHOUR D.D.S. (PRESIDENT/DENTIST)
(570) 825-9645
Entity
Organization
Contact information
Practice address
213 E MARKET ST, WILKES BARRE, PA 18702-5234
(570) 825-9645
(570) 822-6477
Mailing address
213 E MARKET ST, WILKES BARRE, PA 18702-5234
(570) 825-9645
(570) 822-6477
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS019268L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005261110001
—
PA
01
—
42310
UNITED CONCORDIA PROVIDER
PA
Enumeration date
04/13/2006
Last updated
09/15/2015
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