Provider Demographics
NPI:1356552970
Name:WALTER & CHEN, PS
Entity type:Organization
Organization Name:WALTER & CHEN, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-676-8920
Mailing Address - Street 1:3400 SQUALICUM PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1933
Mailing Address - Country:US
Mailing Address - Phone:360-676-8920
Mailing Address - Fax:360-647-5988
Practice Address - Street 1:3400 SQUALICUM PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1933
Practice Address - Country:US
Practice Address - Phone:360-676-8920
Practice Address - Fax:360-647-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6012761001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5317003Medicaid
WA5064902Medicaid
WAG001459101Medicare ID - Type Unspecified
WA5317003Medicaid
WA5064902Medicaid
WAT61010Medicare UPIN