Provider Demographics
NPI:1134266075
Name:WALTERS, DONALD THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:WALTERS
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 1:1215 OLD FAIRHAVEN PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7444
Mailing Address - Country:US
Mailing Address - Phone:360-752-9000
Mailing Address - Fax:
Practice Address - Street 1:1215 OLD FAIRHAVEN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7444
Practice Address - Country:US
Practice Address - Phone:360-752-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:2007-03-06
Deactivation Code:
Reactivation Date:2007-04-17
Provider Licenses
StateLicense IDTaxonomies
WADE000074501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice