Individual
DR. JAY M WALTERS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
526 N DALEVILLE AVE, DALEVILLE, AL 36322-2000
(334) 598-4994
Mailing address
526 N DALEVILLE AVE, DALEVILLE, AL 36322-2000
(334) 598-4994
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4553
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
380241
—
AL
01
—
515-25448
BCBS
AL
01
—
820510
UCCI
AL
Enumeration date
10/10/2006
Last updated
07/08/2007
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