Provider Demographics
NPI:1578532784
Name:WALTERS, CLIFFORD G (DMD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:G
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CHELMSFORD STREET
Mailing Address - Street 2:GREAT HILL DENTAL PARTNERS LLC
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-244-0629
Mailing Address - Fax:978-244-0521
Practice Address - Street 1:122 CHELMSFORD ST
Practice Address - Street 2:GREAT HILL DENTAL PARTNERS LLC
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2732
Practice Address - Country:US
Practice Address - Phone:978-244-0629
Practice Address - Fax:978-244-0521
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH162OtherHARVARD PILGRIM
MAX05754OtherBCBS - DENTAL