Provider Demographics
NPI:1275667891
Name:WALTERS, GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
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 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:503
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-564-2040
Mailing Address - Fax:954-564-2177
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:503
Practice Address - City:FT LAUD
Practice Address - State:FL
Practice Address - Zip Code:33304
Practice Address - Country:US
Practice Address - Phone:954-564-2040
Practice Address - Fax:954-564-2177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice