Provider Demographics
NPI:1104914431
Name:THAMES, WALTER ANDREWS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ANDREWS
Last Name:THAMES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:228 MAIN STREET
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-0388
Mailing Address - Country:US
Mailing Address - Phone:662-963-7338
Mailing Address - Fax:662-963-7339
Practice Address - Street 1:228 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858
Practice Address - Country:US
Practice Address - Phone:662-963-7338
Practice Address - Fax:662-963-7339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2204-851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice