Provider Demographics
NPI:1063455921
Name:LAVERICK, WALTER P (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:P
Last Name:LAVERICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARKWAY CTR
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3510
Mailing Address - Country:US
Mailing Address - Phone:412-937-1900
Mailing Address - Fax:412-937-9014
Practice Address - Street 1:2 PARKWAY CTR
Practice Address - Street 2:SUITE G-1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3510
Practice Address - Country:US
Practice Address - Phone:412-937-1900
Practice Address - Fax:412-937-9014
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADA022458A1223D0004X
SC97231223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116831Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE