Provider Demographics
NPI:1174952899
Name:WALTERS, KRISTEN MASSEY (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MASSEY
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-9597
Mailing Address - Country:US
Mailing Address - Phone:601-683-7878
Mailing Address - Fax:
Practice Address - Street 1:215 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-9597
Practice Address - Country:US
Practice Address - Phone:601-683-7878
Practice Address - Fax:601-683-7272
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3704-13122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist