Provider Demographics
NPI:1457476194
Name:WALTERS, STEPHEN PHILLIP (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PHILLIP
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701
Mailing Address - Country:US
Mailing Address - Phone:406-782-7200
Mailing Address - Fax:406-782-7201
Practice Address - Street 1:25 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:406-782-7200
Practice Address - Fax:406-782-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4571500OtherDENTIST