Provider Demographics
NPI:1598937534
Name:JARRELL, WALTER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
Last Name:JARRELL
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 1:1305 KEEFER STREET
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-351-5403
Mailing Address - Fax:281-255-3980
Practice Address - Street 1:1305 KEEFER STREET
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-351-5403
Practice Address - Fax:281-255-3980
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2010-08-25
Deactivation Date:2008-04-22
Deactivation Code:
Reactivation Date:2010-08-25
Provider Licenses
StateLicense IDTaxonomies
TX77181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7718OtherSTATE DENTAL LICENSE