Provider Demographics
NPI:1043213374
Name:JAVIER, WALTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:JAVIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50014
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0014
Mailing Address - Country:US
Mailing Address - Phone:787-795-7280
Mailing Address - Fax:787-795-7280
Practice Address - Street 1:SA4 CALLE ZEUS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3661
Practice Address - Country:US
Practice Address - Phone:787-795-7280
Practice Address - Fax:787-795-7280
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice