Provider Demographics
NPI:1790520211
Name:STALLINGS, WALTER CALEB (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CALEB
Last Name:STALLINGS
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 1:4311 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9152
Mailing Address - Country:US
Mailing Address - Phone:601-527-4296
Mailing Address - Fax:
Practice Address - Street 1:4311 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9152
Practice Address - Country:US
Practice Address - Phone:850-932-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL307411223G0001X
TN125541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice