Provider Demographics
NPI:1376554642
Name:DAVIS, WALTER E (DDS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:DAVIS
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 1:415 S YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5955
Mailing Address - Country:US
Mailing Address - Phone:918-682-1961
Mailing Address - Fax:918-682-0101
Practice Address - Street 1:415 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5955
Practice Address - Country:US
Practice Address - Phone:918-682-1961
Practice Address - Fax:918-682-0101
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice