Provider Demographics
NPI:1346423316
Name:MELVIN W. WALTERS, DDS - A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MELVIN W. WALTERS, DDS - A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-575-9990
Mailing Address - Street 1:4450 DUCKHORN DR STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2589
Mailing Address - Country:US
Mailing Address - Phone:916-575-9990
Mailing Address - Fax:
Practice Address - Street 1:4450 DUCKHORN DR STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2589
Practice Address - Country:US
Practice Address - Phone:916-575-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17796261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental