Active NPI
John Douglas Walters, D.D.S.
- Periodontics
- Columbus, OH
National Provider Identifier
1194809897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 30-017764
- Practice address
- 305 W 12TH Ave
Dental Faculty Practice Association Inc
Columbus, OH 43210-1267 - Phone
- (614) 292-1472
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30-017764 | OH | Primary |
Addresses
Primary practice location
305 W 12TH Ave
Dental Faculty Practice Association Inc
Columbus, OH 43210-1267
Mailing address
305 W 12TH Ave RM 4113
Ohio State University College of Dentistry
Columbus, OH 43210-1267
Phone (614) 292-1169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-017764 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194809897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W 12TH AVE RM 4113",
"address_2": "OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-1169",
"fax_number": "614-292-2438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"address_2": "DENTAL FACULTY PRACTICE ASSOCIATION INC",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-1472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "JOHN",
"middle_name": "DOUGLAS",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "30-017764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.