Provider Demographics
NPI:1710094412
Name:WALTERS, SYDNEY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 NE 24TH ST
Mailing Address - Street 2:STE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008
Mailing Address - Country:US
Mailing Address - Phone:425-643-6072
Mailing Address - Fax:425-643-1169
Practice Address - Street 1:15710 NE 24TH ST
Practice Address - Street 2:STE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008
Practice Address - Country:US
Practice Address - Phone:425-643-6072
Practice Address - Fax:425-643-1169
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist