Provider Demographics
NPI:1568566818
Name:BICKNESE, WALTER K (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:K
Last Name:BICKNESE
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 1:413 SE 42ND TERRACE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-542-7432
Mailing Address - Fax:
Practice Address - Street 1:1105 SE 47TH TERRACE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-542-4626
Practice Address - Fax:239-542-1323
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY99791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice