Individual
ROBERT DOUGLAS WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
46444
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46444
STATE LICENSE
CA
Enumeration date
10/15/2009
Last updated
10/15/2009
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