Provider Demographics
NPI:1427015668
Name:MAGANN, WALTER EDMUND JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EDMUND
Last Name:MAGANN
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 1:100A STROUD BUILDING
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9064
Mailing Address - Country:US
Mailing Address - Phone:570-421-3751
Mailing Address - Fax:570-421-0274
Practice Address - Street 1:100A STROUD BUILDING
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9064
Practice Address - Country:US
Practice Address - Phone:570-421-3751
Practice Address - Fax:570-421-0274
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0216751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159831OtherUNITED CONCORDIA PROVIDER