Provider Demographics
NPI:1053086157
Name:WALTER D. THAMES, PLLC
Entity type:Organization
Organization Name:WALTER D. THAMES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:THAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:210-888-5832
Mailing Address - Street 1:10650 CULEBRA RD STE 136
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4950
Mailing Address - Country:US
Mailing Address - Phone:210-888-5832
Mailing Address - Fax:
Practice Address - Street 1:10650 CULEBRA RD STE 136
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4950
Practice Address - Country:US
Practice Address - Phone:210-888-5832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental