Individual
DR. DOUGLAS C WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
128 PENNSYLVANIA AVE E, WARREN, PA 16365-2533
(814) 723-4488
(814) 723-0769
Mailing address
128 PENNSYLVANIA AVE E, WARREN, PA 16365-2533
(814) 723-4488
(814) 723-0769
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS 017588 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0696612
—
PA
Enumeration date
06/12/2006
Last updated
07/08/2007
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