Individual
KIMBERLY WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
701 PARK AVENUE SOUTH, MINNEAPOLIS, MN 55415
(612) 873-3000
Mailing address
1251 LANCASTER DR NE, SUITE A, SALEM, OR 97301
(503) 391-2219
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D008447
AZ
122300000X
Dentist
D10041
OR
1223G0001X
General Practice Dentistry
61829
CA
Other
Enumeration date
09/05/2012
Last updated
04/22/2020
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