Provider Demographics
NPI:1841210242
Name:GLEASON, WALTER J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:GLEASON
Suffix:JR
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 1:488 CONCHESTER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19014
Mailing Address - Country:US
Mailing Address - Phone:610-485-2600
Mailing Address - Fax:610-485-2407
Practice Address - Street 1:450 CHERRY TREE RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2406
Practice Address - Country:US
Practice Address - Phone:610-485-2600
Practice Address - Fax:610-485-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025850L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice