Provider Demographics
NPI:1255341921
Name:WALTERS, DANA R (DDS)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:R
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 1:3905 BERRY LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-3140
Mailing Address - Country:US
Mailing Address - Phone:614-771-5960
Mailing Address - Fax:614-771-0899
Practice Address - Street 1:3905 BERRY LEAF LN
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-3140
Practice Address - Country:US
Practice Address - Phone:614-771-5960
Practice Address - Fax:614-771-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice