Provider Demographics
NPI:1538313481
Name:WALTERS CARGILL, SACHA DELISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SACHA
Middle Name:DELISA
Last Name:WALTERS CARGILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1563
Mailing Address - Country:US
Mailing Address - Phone:240-670-4780
Mailing Address - Fax:
Practice Address - Street 1:10801 LOCKWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1563
Practice Address - Country:US
Practice Address - Phone:240-670-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172021223P0221X, 1223G0001X
TNDS00000101501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083367734OtherGROUP NPI