Provider Demographics
NPI:1396848917
Name:WALTERS, RICHARD LEIGH (DMD LLC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEIGH
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DMD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1600
Mailing Address - Country:US
Mailing Address - Phone:717-533-3030
Mailing Address - Fax:717-533-4459
Practice Address - Street 1:537 W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1600
Practice Address - Country:US
Practice Address - Phone:717-533-3030
Practice Address - Fax:717-533-4459
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist