Individual
JOHN DOUGLAS WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
305 W 12TH AVE, DENTAL FACULTY PRACTICE ASSOCIATION INC, COLUMBUS, OH 43210-1267
(614) 292-1472
Mailing address
305 W 12TH AVE RM 4113, OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY, COLUMBUS, OH 43210-1267
(614) 292-1169
(614) 292-2438
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
30-017764
OH
Other
Enumeration date
10/25/2006
Last updated
07/08/2007
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