Provider Demographics
NPI:1629292370
Name:WALTHER, THOMAS STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEVEN
Last Name:WALTHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42 4 SEASONS SHOPPING CTR
Mailing Address - Street 2:SUITE 128
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3195
Mailing Address - Country:US
Mailing Address - Phone:314-469-1950
Mailing Address - Fax:314-205-8778
Practice Address - Street 1:42 4 SEASONS SHOPPING CTR
Practice Address - Street 2:SUITE 128
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3195
Practice Address - Country:US
Practice Address - Phone:314-469-1950
Practice Address - Fax:314-205-8778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO137931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice