Provider Demographics
NPI:1174075436
Name:WALTER D. FELTON, DDS
Entity type:Organization
Organization Name:WALTER D. FELTON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-717-2099
Mailing Address - Street 1:10611 GREENYARD WAY
Mailing Address - Street 2:STE A
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1484
Mailing Address - Country:US
Mailing Address - Phone:804-717-2099
Mailing Address - Fax:804-717-9383
Practice Address - Street 1:10611 GREENYARD WAY
Practice Address - Street 2:STE A
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1484
Practice Address - Country:US
Practice Address - Phone:804-717-2099
Practice Address - Fax:804-717-9383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010064071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty