Provider Demographics
NPI:1154331023
Name:DAVIS, WALTER SELLERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:SELLERS
Last Name:DAVIS
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 1:1610 CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5407
Mailing Address - Country:US
Mailing Address - Phone:303-442-5000
Mailing Address - Fax:303-442-4396
Practice Address - Street 1:1610 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5407
Practice Address - Country:US
Practice Address - Phone:303-442-5000
Practice Address - Fax:303-442-4396
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice