MEDICARE: WALTER J. DECK, D.M.D., P.C.

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	0404321	NY

General Provider Information

NPI Number	:	1720140817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER J. DECK, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	1625 STATE ROUTE 332
Second Line	:	SUITE 1-A
City	:	FARMINGTON
State	:	NY
Zip	:	14425-9601
Country	:	US
Telephone Number	:	585-398-3810
Fax Number	:	585-398-2413

Provider Business Practice Location Address
First Line	:	1625 STATE ROUTE 332
Second Line	:	SUITE 1-A
City	:	FARMINGTON
State	:	NY
Zip	:	14425-9601
Country	:	US
Telephone Number	:	585-398-3810
Fax Number	:	585-398-2413

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WALTER JAMES DECK
Credential	:	D.M.D.
Telephone Number	:	585-398-3810

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	01/30/2012

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