Provider Demographics
NPI:1407878572
Name:EANES, WALTER CLYDE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CLYDE
Last Name:EANES
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 1:14800 4TH ST
Mailing Address - Street 2:STE 14A
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3708
Mailing Address - Country:US
Mailing Address - Phone:301-498-1414
Mailing Address - Fax:301-498-9915
Practice Address - Street 1:14800 4TH ST STE 14A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3708
Practice Address - Country:US
Practice Address - Phone:301-498-1414
Practice Address - Fax:301-498-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD42381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice