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General NPI Number Information
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NPI Number | 1578532784
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Entity Type | Individual
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Provider Name | CLIFFORD G. WALTERS DMD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 122 CHELMSFORD ST GREAT HILL DENTAL PARTNERS LLC
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City | CHELMSFORD
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State | MA
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Zip | 01824-2732
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Country | US
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Telephone | 978-244-0629
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Fax | 978-244-0521
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Provider Business Mailing Address
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Address Line | 122 CHELMSFORD STREET GREAT HILL DENTAL PARTNERS LLC
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City | CHELMSFORD
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State | MA
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Zip | 01824
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Country | US
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Telephone | 978-244-0629
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Fax | 978-244-0521
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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 | 15547
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License Number State | MA
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