Provider Demographics
NPI:1467572347
Name:GRACE, WALTER JAMES III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAMES
Last Name:GRACE
Suffix:III
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 1:1712 I ST NW
Mailing Address - Street 2:SUITE 412
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3702
Mailing Address - Country:US
Mailing Address - Phone:202-223-2070
Mailing Address - Fax:202-223-2224
Practice Address - Street 1:1712 I ST NW
Practice Address - Street 2:SUITE 412
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-223-2070
Practice Address - Fax:202-223-2224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC38881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice