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General NPI Number Information
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NPI Number | 1366022006
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Entity Type | Individual
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Provider Name | KIREN KAUR WALTERS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 4780 CLAGUE RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3758
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Country | US
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Telephone | 440-777-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 794 N GREENWAY DR
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City | WESTLAKE
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State | OH
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Zip | 44145-1250
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 30.026560
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License Number State | OH
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