Provider Demographics
NPI:1487217626
Name:FUENTES, WALTER VLADIMIR (DDS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:VLADIMIR
Last Name:FUENTES
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 1:6222 NE 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8158
Mailing Address - Country:US
Mailing Address - Phone:206-543-7906
Mailing Address - Fax:
Practice Address - Street 1:6222 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
Practice Address - Country:US
Practice Address - Phone:206-543-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program