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General NPI Number Information
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NPI Number | 1144908005
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Entity Type | Individual
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Provider Name | MIRANDA LOBELL WALTERS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 900 N CAUSEWAY BLVD
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City | METAIRIE
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State | LA
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Zip | 70001-5348
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Country | US
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Telephone | 504-835-8741
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 CIVIC ST
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City | METAIRIE
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State | LA
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Zip | 70001-4910
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Country | US
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Telephone | 985-507-2379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7453
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3471556
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License Number State | ID
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