MEDICARE: DR. WALTER JAVIER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1777	PR

General Provider Information

NPI Number	:	1043213374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER JAVIER D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 50014
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-0014
Country	:	US
Telephone Number	:	787-795-7280
Fax Number	:	787-795-7280

Provider Business Practice Location Address
First Line	:	SA4 CALLE ZEUS
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3661
Country	:	US
Telephone Number	:	787-795-7280
Fax Number	:	787-795-7280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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