Provider Demographics
NPI:1780797316
Name:WEST, WALTER DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DEAN
Last Name:WEST
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 1:12115 TESSON FERRY PROFESSIONAL CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1250
Mailing Address - Country:US
Mailing Address - Phone:314-842-4366
Mailing Address - Fax:314-729-1730
Practice Address - Street 1:12115 TESSON FERRY PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1250
Practice Address - Country:US
Practice Address - Phone:314-842-4366
Practice Address - Fax:314-729-1730
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice