Provider Demographics
NPI:1336395854
Name:WALTUCH, SHELDON (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:WALTUCH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3 STATE HIGHWAY 27
Mailing Address - Street 2:COLONIAL VILLAGE PROFESSIONAL BUILDING
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-549-6286
Mailing Address - Fax:732-549-5282
Practice Address - Street 1:3 STATE HIGHWAY 27
Practice Address - Street 2:COLONIAL VILLAGE PROFESSIOAL BLDG. SUITE204
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-549-6286
Practice Address - Fax:732-549-5282
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22D1013556001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics