Provider Demographics
NPI:1871703439
Name:PHILIP C WALTER DDS PC
Entity type:Organization
Organization Name:PHILIP C WALTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-906-1366
Mailing Address - Street 1:11241 E CIMMARRON DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4009
Mailing Address - Country:US
Mailing Address - Phone:303-906-1366
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:SUITE 255
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5432
Practice Address - Country:US
Practice Address - Phone:303-369-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental