Provider Demographics
NPI:1710152681
Name:GILLIN, WALTER ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ALLEN
Last Name:GILLIN
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 1:208 SAINT CLAIRE PL
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2170
Mailing Address - Country:US
Mailing Address - Phone:410-643-8110
Mailing Address - Fax:410-643-5311
Practice Address - Street 1:208 SAINT CLAIRE PL
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2170
Practice Address - Country:US
Practice Address - Phone:410-643-8110
Practice Address - Fax:410-643-5311
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice