Provider Demographics
NPI:1083827794
Name:KAMINSKI, WALTER JOHN JR (DDS)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:JOHN
Last Name:KAMINSKI
Suffix:JR
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 1:102 DEWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2117
Mailing Address - Country:US
Mailing Address - Phone:302-239-7418
Mailing Address - Fax:
Practice Address - Street 1:100 CHRISTIANA VILLAGE PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-738-3666
Practice Address - Fax:302-738-8773
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE8621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDE0234OtherSTATE NARCOTIC IDENTIFIER
DEAK7728984OtherDEA