Provider Demographics
NPI:1174541361
Name:ANDERSON, WALTER E (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:ANDERSON
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 1:1930 HIGHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-7802
Mailing Address - Country:US
Mailing Address - Phone:706-738-1231
Mailing Address - Fax:706-738-1474
Practice Address - Street 1:1930 HIGHLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-7802
Practice Address - Country:US
Practice Address - Phone:706-738-1231
Practice Address - Fax:706-738-1474
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0070121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice