Individual
DR. NATHAN FREDERICK WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2800 CANNONS LN STE 200, LOUISVILLE, KY 40205-2164
(502) 454-4885
(502) 452-1926
Mailing address
2800 CANNONS LN STE 200, LOUISVILLE, KY 40205-2164
(502) 454-4885
(502) 452-1926
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8066
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
8066
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000339061
BC/BS
KY
05
—
200498320
—
IN
05
—
60002789
—
KY
05
—
64082688
—
KY
Enumeration date
08/18/2005
Last updated
11/12/2018
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