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General NPI Number Information
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NPI Number | 1346423316
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Entity Type | Organization
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Legal Business Name | MELVIN W. WALTERS, DDS - A DENTAL CORPORATION
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 4450 DUCKHORN DR STE B
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City | SACRAMENTO
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State | CA
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Zip | 95834-2589
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Country | US
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Telephone | 916-575-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 DUCKHORN DR STE B
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City | SACRAMENTO
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State | CA
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Zip | 95834-2589
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Country | US
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Telephone | 916-575-9990
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. MELVIN WESLEY WALTERS
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Credential | DDS
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Telephone | 916-575-9990
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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 | 17796
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License Number State | CA
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