Provider Demographics
NPI:1083748487
Name:WALKER, THOMAS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 SW MARLOW AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5178
Mailing Address - Country:US
Mailing Address - Phone:503-729-6662
Mailing Address - Fax:503-746-7979
Practice Address - Street 1:1585 SW MARLOW AVE STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5178
Practice Address - Country:US
Practice Address - Phone:503-729-6662
Practice Address - Fax:503-746-7979
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR41771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice