NPIMap

Organization Active NPI

Dr. Todd W. Walters P.C.

  • General Practice Dentistry
  • Logansport, IN
National Provider Identifier
1760568307
Registry record updated Feb 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12008831 Issued in IN
Legal business name
DR. TODD W. WALTERS P.C.
Practice address
800 Fulton St Ste 4a
Logansport, IN 46947-1579
Phone
(574) 722-5313
Fax
(574) 753-3025
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Todd Wayne Walters, D.D.S.NPI 1932341542
Title
President -Owner
Phone
(574) 722-5313

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12008831 IN Primary

Addresses

Primary practice location

800 Fulton St Ste 4a
Logansport, IN 46947-1579

Mailing address

800 Fulton St Ste 4a
Logansport, IN 46947-1579
Phone (574) 722-5313

Other identifiers 1

IdentifierTypeStateIssuer
100070910MedicaidIN

National Provider Directory

National Provider Directory

Locations

800 Fulton St
Ste 4A
Logansport, IN 46947
Phone (574) 722-5313

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298592000000",
    "number": "1760568307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 FULTON ST STE 4A",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471579",
            "telephone_number": "574-722-5313",
            "fax_number": "574-753-3025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 FULTON ST STE 4A",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471579",
            "telephone_number": "574-722-5313",
            "fax_number": "574-753-3025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TODD W. WALTERS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2011-02-25",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT -OWNER",
        "authorized_official_telephone_number": "574-722-5313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070910",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.