MEDICARE: WALTERS FAMILY DENISTRY

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	124Q00000X	Dental Hygienist
2	126800000X	Dental Assistant
3	1223G0001X	General Practice Dentistry	020238	OH

General Provider Information

NPI Number	:	1770633075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTERS FAMILY DENISTRY

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	:

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	:

Authorized Official
Title or Position	:	CREDENTIALING ANALYST
Name	:	CYNTHIA TALBERT
Credential	:
Telephone Number	:	330-353-6425

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	03/04/2025

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