Provider Demographics
NPI:1982611661
Name:DECK, WALTER JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAMES
Last Name:DECK
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 1:1625 STATE ROUTE 332
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9601
Mailing Address - Country:US
Mailing Address - Phone:585-398-3810
Mailing Address - Fax:585-398-2413
Practice Address - Street 1:1625 STATE ROUTE 332
Practice Address - Street 2:SUITE 1-A
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9601
Practice Address - Country:US
Practice Address - Phone:585-398-3810
Practice Address - Fax:585-398-2413
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0404321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist