Provider Demographics
NPI:1144230574
Name:WALTERS, SCOTT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:WALTERS
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 1:2025 MEADOWVIEW PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7386
Mailing Address - Country:US
Mailing Address - Phone:423-247-6521
Mailing Address - Fax:423-247-0191
Practice Address - Street 1:2025 MEADOWVIEW PKWY
Practice Address - Street 2:STE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7386
Practice Address - Country:US
Practice Address - Phone:423-247-6521
Practice Address - Fax:423-247-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice