MEDICARE: DR. WALTER SMITH LINVILLE 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	2481	NC

General Provider Information

NPI Number	:	1679578900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER SMITH LINVILLE DDS

Provider Business Mailing Address
First Line	:	603 NASH ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3059
Country	:	US
Telephone Number	:	252-237-5124
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 NASH ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3059
Country	:	US
Telephone Number	:	252-237-5124
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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