MEDICARE: DR. MALCOLM WALTERS JR. DDS

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	20238	OH

General Provider Information

NPI Number	:	1356333157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALCOLM WALTERS JR. DDS

Provider Business Mailing Address
First Line	:	3461 WARRENSVILLE CENTER RD STE 301
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5227
Country	:	US
Telephone Number	:	216-382-1102
Fax Number	:	216-382-1104

Provider Business Practice Location Address
First Line	:	3461 WARRENSVILLE CENTER RD STE 301
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5227
Country	:	US
Telephone Number	:	216-382-1102
Fax Number	:	216-382-1104

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/04/2025

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