Individual
DR. WALTER VINCENT SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2605 64TH AVE S, FARGO, ND 58104-7403
(701) 799-4381
Mailing address
2605 64TH AVE S, FARGO, ND 58104-7403
(701) 799-4381
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/26/2009
Last updated
05/26/2009
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