Provider Demographics
NPI:1871555383
Name:FAHEY, WALTER JOSEPH (DDS)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JOSEPH
Last Name:FAHEY
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 1:1131 S 119 STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1601
Mailing Address - Country:US
Mailing Address - Phone:402-333-0186
Mailing Address - Fax:402-333-9842
Practice Address - Street 1:1131 S 119 STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1601
Practice Address - Country:US
Practice Address - Phone:402-333-0186
Practice Address - Fax:402-333-9842
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist