Individual
DR. JEFFREY MARK WALTERS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
116 BROADWAY, AMITYVILLE, NY 11701-2797
(631) 264-2610
Mailing address
881 GARDINER DR, BAY SHORE, NY 11706-7602
(631) 666-6367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
028643
NY
Other
Enumeration date
10/12/2005
Last updated
07/08/2007
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