Provider Demographics
NPI:1407950033
Name:WALTERS, THOMAS ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLAN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LAKE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1242
Mailing Address - Country:US
Mailing Address - Phone:814-897-8008
Mailing Address - Fax:
Practice Address - Street 1:93 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1133
Practice Address - Country:US
Practice Address - Phone:814-725-4700
Practice Address - Fax:814-725-3953
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030232L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice