Provider Demographics
NPI:1306010780
Name:WALTER B. FUTCH, JR. DDS PA
Entity Type:Organization
Organization Name:WALTER B. FUTCH, JR. DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-371-9444
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:1006 NORTHGATE DRIVE
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0557
Mailing Address - Country:US
Mailing Address - Phone:910-371-9444
Mailing Address - Fax:910-371-9474
Practice Address - Street 1:1006 NORTHGATE DRIVE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-371-9444
Practice Address - Fax:910-371-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty