Provider Demographics
NPI:1013358456
Name:WALTERS, JOEL ARLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ARLAN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6938
Mailing Address - Country:US
Mailing Address - Phone:616-392-1108
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON AVE STE 4100
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7196
Practice Address - Country:US
Practice Address - Phone:616-392-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist