Provider Demographics
NPI:1134320864
Name:DOBBINS, WALTER NOLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:NOLAN
Last Name:DOBBINS
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 1:6909 SHERWOOD RD
Mailing Address - Street 2:5463 LEBANON AVENUE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2324
Mailing Address - Country:US
Mailing Address - Phone:215-473-3288
Mailing Address - Fax:215-473-3288
Practice Address - Street 1:5463 LEBANON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3124
Practice Address - Country:US
Practice Address - Phone:215-473-3288
Practice Address - Fax:215-473-3288
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017391-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA06335OtherUNITED CONCORDIA