Provider Demographics
NPI:1114367281
Name:WALTERS, DOREEN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:E
Last Name:WALTERS
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 1:2120 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5122
Mailing Address - Country:US
Mailing Address - Phone:717-795-9392
Mailing Address - Fax:717-795-5494
Practice Address - Street 1:2120 FISHER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5122
Practice Address - Country:US
Practice Address - Phone:717-795-9392
Practice Address - Fax:717-795-5494
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029788-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice