MEDICARE: DR. EDWARD J WALTER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20959	CA

General Provider Information

NPI Number	:	1023007960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD J WALTER D.D.S.

Provider Business Mailing Address
First Line	:	2427 CHESTNUT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2505
Country	:	US
Telephone Number	:	415-563-2717
Fax Number	:	415-563-2719

Provider Business Practice Location Address
First Line	:	2427 CHESTNUT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2505
Country	:	US
Telephone Number	:	415-563-2717
Fax Number	:	415-563-2719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	01/29/2009

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