Provider Demographics
NPI:1922124338
Name:FORMBY, WALTER ANTHONY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ANTHONY
Last Name:FORMBY
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:9826 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4549
Mailing Address - Country:US
Mailing Address - Phone:972-475-9660
Mailing Address - Fax:972-463-0018
Practice Address - Street 1:9826 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4549
Practice Address - Country:US
Practice Address - Phone:972-475-9660
Practice Address - Fax:972-463-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX160501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics