Provider Demographics
NPI:1295742070
Name:WALTKE, DENNIS J (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:WALTKE
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 1:7373 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1753
Mailing Address - Country:US
Mailing Address - Phone:317-357-7373
Mailing Address - Fax:317-353-2330
Practice Address - Street 1:7373 E 21ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1718
Practice Address - Country:US
Practice Address - Phone:317-357-7373
Practice Address - Fax:317-353-2330
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007396A1223G0001X
IN120073961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice