Provider Demographics
NPI:1063806875
Name:WALTER, ALYS MARIE (DMD)
Entity type:Individual
Prefix:MRS
First Name:ALYS
Middle Name:MARIE
Last Name:WALTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:ALYS
Other - Middle Name:
Other - Last Name:MURDOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:835 BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1384
Mailing Address - Country:US
Mailing Address - Phone:908-859-4555
Mailing Address - Fax:
Practice Address - Street 1:835 BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1384
Practice Address - Country:US
Practice Address - Phone:908-859-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0402381223X0400X
NJ22DI026546001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics