Provider Demographics
NPI:1417073313
Name:WALROD, JOHN HAMILTON (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HAMILTON
Last Name:WALROD
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 1:15 CLEVELAND AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-632-1265
Mailing Address - Fax:276-632-4753
Practice Address - Street 1:15 CLEVELAND AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-632-1265
Practice Address - Fax:276-632-4753
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA51681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA173458OtherANTHEM