Provider Demographics
NPI:1184863466
Name:WALTH, DANIEL ERWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERWIN
Last Name:WALTH
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54015-0488
Mailing Address - Country:US
Mailing Address - Phone:715-796-2261
Mailing Address - Fax:
Practice Address - Street 1:979 DAVIS ST.
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:WI
Practice Address - Zip Code:54015
Practice Address - Country:US
Practice Address - Phone:715-796-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist