Provider Demographics
NPI:1275689572
Name:WALTER, DONALD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:WALTER
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 1:1 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5442
Mailing Address - Country:US
Mailing Address - Phone:304-242-9550
Mailing Address - Fax:304-242-9505
Practice Address - Street 1:1 PARK VIEW LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5442
Practice Address - Country:US
Practice Address - Phone:304-242-9550
Practice Address - Fax:304-242-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132743000Medicaid