Provider Demographics
NPI:1477538924
Name:WALTERS, GEORGE JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOHN
Last Name:WALTERS
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 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-763-8585
Mailing Address - Fax:850-763-3920
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-763-8585
Practice Address - Fax:850-763-3920
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00124321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073701101Medicaid
FLU10820Medicare UPIN