Provider Demographics
NPI:1356333157
Name:WALTERS, MALCOLM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:WALTERS
Suffix:JR
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 1:14100 CEDAR RD
Mailing Address - Street 2:260
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-382-1102
Mailing Address - Fax:216-382-1104
Practice Address - Street 1:14100 CEDAR RD
Practice Address - Street 2:260
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-382-1102
Practice Address - Fax:216-382-1104
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH202381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice