Individual
WADE CODY WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2300 N 14TH STREET, SUITE 202, DODGE CITY, KS 67801
(620) 225-2650
(620) 225-7722
Mailing address
2300 N 14TH STREET, SUITE 202, DODGE CITY, KS 67801
(620) 225-2650
(620) 225-7722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7008
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417934
UNITED CONCORDIA
KS
01
—
59642
BC & BS OF KANSAS
KS
Enumeration date
12/01/2006
Last updated
12/02/2009
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