Individual
MADELEINE LANE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
5900 E VIRGINIA BEACH BLVD, NORFOLK, VA 23502-2530
(757) 244-9734
Mailing address
230 E 40TH ST APT D4, NORFOLK, VA 23504-1050
(434) 996-9051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401419929
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401419929
STATE DENTAL LICENSE
VA
Enumeration date
08/04/2026
Last updated
08/04/2026
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