Provider Demographics
NPI:1366442188
Name:EASTER, WALTER R (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
Last Name:EASTER
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 1:6920 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3202
Mailing Address - Country:US
Mailing Address - Phone:510-569-4323
Mailing Address - Fax:510-569-4372
Practice Address - Street 1:6920 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3202
Practice Address - Country:US
Practice Address - Phone:510-569-4323
Practice Address - Fax:510-569-4372
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB31457-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice