Provider Demographics
NPI:1427298595
Name:WALMAN, PETER LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LOUIS
Last Name:WALMAN
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 1:11601 MINNETONKA MILLS RD.
Mailing Address - Street 2:B-30
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5176
Mailing Address - Country:US
Mailing Address - Phone:952-933-6060
Mailing Address - Fax:952-933-6838
Practice Address - Street 1:11601 MINNETONKA MILLS RD.
Practice Address - Street 2:B-30
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5176
Practice Address - Country:US
Practice Address - Phone:952-933-6060
Practice Address - Fax:952-933-6838
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND73701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice