MEDICARE: DR. WALTER JAMES DECK DMD

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	122300000X	Dentist	0404321	NY

General Provider Information

NPI Number	:	1982611661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER JAMES DECK DMD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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