Provider Demographics
NPI:1669407045
Name:WALTERS, TIMOTHY RYAN (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RYAN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-1158
Mailing Address - Country:US
Mailing Address - Phone:717-561-0706
Mailing Address - Fax:
Practice Address - Street 1:2701 DUKE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1158
Practice Address - Country:US
Practice Address - Phone:717-561-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0240921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice