Provider Demographics
NPI:1689687063
Name:WALTER, JAMES D (DMD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:WALTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:D
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:150 RIVER RD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9441
Mailing Address - Country:US
Mailing Address - Phone:973-334-4114
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9441
Practice Address - Country:US
Practice Address - Phone:973-334-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI166361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice