Individual
DR. TODD W WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
800 FULTON ST STE 4A, LOGANSPORT, IN 46947-1579
(574) 722-5313
(574) 753-3025
Mailing address
800 FULTON ST STE 4A, LOGANSPORT, IN 46947-1579
(574) 722-5313
(574) 753-3025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008831A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100070910
—
IN
Enumeration date
03/27/2009
Last updated
02/25/2011
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