Provider Demographics
NPI:1588645592
Name:ANDREWS, WALTER ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ALAN
Last Name:ANDREWS
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 1:1419 S SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5361
Mailing Address - Country:US
Mailing Address - Phone:505-546-0415
Mailing Address - Fax:505-546-0470
Practice Address - Street 1:1419 S SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5361
Practice Address - Country:US
Practice Address - Phone:505-546-0415
Practice Address - Fax:505-546-0470
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD 14351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8616Medicaid