Provider Demographics
NPI:1023007960
Name:WALTER, EDWARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:WALTER
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 1:2427 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2505
Mailing Address - Country:US
Mailing Address - Phone:415-563-2717
Mailing Address - Fax:415-563-2719
Practice Address - Street 1:2427 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2505
Practice Address - Country:US
Practice Address - Phone:415-563-2717
Practice Address - Fax:415-563-2719
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice