Provider Demographics
NPI:1124209465
Name:H. CARROLL WALKER, JR., DDS,PA
Entity Type:Organization
Organization Name:H. CARROLL WALKER, JR., DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-323-9726
Mailing Address - Street 1:100 BRANDON RD STE W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2571
Mailing Address - Country:US
Mailing Address - Phone:662-323-9726
Mailing Address - Fax:662-323-9727
Practice Address - Street 1:100 BRANDON RD STE W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2571
Practice Address - Country:US
Practice Address - Phone:662-323-9726
Practice Address - Fax:662-323-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO-006-741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09205284Medicaid