Provider Demographics
NPI:1558557009
Name:WALTERS, STEVEN BLAIR (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BLAIR
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 1:26777 LORAIN RD STE 614
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3222
Mailing Address - Country:US
Mailing Address - Phone:440-777-2757
Mailing Address - Fax:440-777-4479
Practice Address - Street 1:26777 LORAIN RD STE 614
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3222
Practice Address - Country:US
Practice Address - Phone:440-777-2757
Practice Address - Fax:440-777-4479
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice