Individual
JERE P WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
238 S IDAHO ST, BUTTE, MT 59701-1614
(406) 782-8719
Mailing address
238 S IDAHO ST, BUTTE, MT 59701-1614
(406) 782-8719
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2070
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112801
—
MT
01
—
1501839
UNITED CONCORDIA
—
01
—
41054
BLUE CROSS
—
01
—
5512429
CHIP
MT
Enumeration date
01/05/2007
Last updated
07/08/2007
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