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General NPI Number Information
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NPI Number | 1770633075
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Entity Type | Organization
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Legal Business Name | WALTERS FAMILY DENISTRY
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 3461 WARRENSVILLE CENTER RD STE 301
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5227
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Country | US
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Telephone | 216-382-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 3461 WARRENSVILLE CENTER RD STE 301
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5227
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Country | US
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Telephone | 216-382-1102
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ANALYST
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Name | CYNTHIA TALBERT
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Credential |
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Telephone | 330-353-6425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 020238
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License Number State | OH
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