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General NPI Number Information
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NPI Number | 1144708660
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Entity Type | Organization
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Legal Business Name | WALTERS FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 844 WASHINGTON AVE STE 4100
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City | HOLLAND
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State | MI
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Zip | 49423-7196
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Country | US
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Telephone | 616-392-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 1954 64TH AVE
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City | ZEELAND
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State | MI
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Zip | 49464-9308
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Country | US
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Telephone | 616-218-5919
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JOEL WALTERS
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Credential | DDS
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Telephone | 616-218-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901020963
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License Number State | MI
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