Provider Demographics
NPI:1427120989
Name:DORNEMANN, WALTER E (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:DORNEMANN
Suffix:
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 1:164 S COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2516
Mailing Address - Country:US
Mailing Address - Phone:631-286-2211
Mailing Address - Fax:631-286-2168
Practice Address - Street 1:164 S COUNTRY RD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2516
Practice Address - Country:US
Practice Address - Phone:631-286-2211
Practice Address - Fax:631-286-2168
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0315271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice