Provider Demographics
NPI:1144908005
Name:WALTERS, MIRANDA LOBELL (DDS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LOBELL
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 1:3936 CIVIC ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4910
Mailing Address - Country:US
Mailing Address - Phone:985-507-2379
Mailing Address - Fax:
Practice Address - Street 1:900 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5348
Practice Address - Country:US
Practice Address - Phone:504-835-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74531223G0001X
ID34715561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice