Provider Demographics
NPI:1063854149
Name:WALTER, MADELINE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:M
Last Name:WALTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 NORHARDT DR
Mailing Address - Street 2:#110
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5089
Mailing Address - Country:US
Mailing Address - Phone:319-321-2070
Mailing Address - Fax:
Practice Address - Street 1:231 LAWN STREET
Practice Address - Street 2:MODERN TOUCH DENTAL
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029
Practice Address - Country:US
Practice Address - Phone:262-367-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7124-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist