Provider Demographics
NPI:1891013371
Name:WALTUCH, ALLON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLON
Middle Name:
Last Name:WALTUCH
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 1:125 N WOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2123
Mailing Address - Country:US
Mailing Address - Phone:516-596-8854
Mailing Address - Fax:
Practice Address - Street 1:37 WOODMERE BLVD APT 4A
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2113
Practice Address - Country:US
Practice Address - Phone:516-596-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0556201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist