Provider Demographics
NPI:1720894991
Name:WALTERS, CARRIE RENAE (DMD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:RENAE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-6706
Mailing Address - Country:US
Mailing Address - Phone:270-723-1020
Mailing Address - Fax:
Practice Address - Street 1:1602 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5458
Practice Address - Country:US
Practice Address - Phone:270-723-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist