Organization
DALEVILLE DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY MICHAEL WALTERS D.D.S. (OWNER)
(334) 598-4994
Entity
Organization
Contact information
Practice address
526 N DALEVILLE AVE, DALEVILLE, AL 36322-2000
(334) 598-4994
(334) 598-4342
Mailing address
526 N DALEVILLE AVE, DALEVILLE, AL 36322-2000
(334) 598-4994
(334) 598-4342
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4553
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51525448
BC/BS
AL
01
—
820510
UCCI
—
Enumeration date
09/12/2005
Last updated
08/22/2020
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