Provider Demographics
NPI:1841315710
Name:WALTERS, COLIN (DMD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
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 1:208 PIRKLE FERRY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2526
Mailing Address - Country:US
Mailing Address - Phone:770-781-0888
Mailing Address - Fax:770-234-5390
Practice Address - Street 1:208 PIRKLE FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2526
Practice Address - Country:US
Practice Address - Phone:770-781-0888
Practice Address - Fax:706-234-5390
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice