Provider Demographics
NPI:1679691992
Name:CHITWOOD, WALTER C JR
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:C
Last Name:CHITWOOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2340
Mailing Address - Country:US
Mailing Address - Phone:615-893-8771
Mailing Address - Fax:615-893-8781
Practice Address - Street 1:1110 W CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2340
Practice Address - Country:US
Practice Address - Phone:615-893-8771
Practice Address - Fax:615-893-8781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0040791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice