Provider Demographics
NPI:1154052090
Name:PRINCE, CARL WALKER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:WALKER
Last Name:PRINCE
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 1:5201 CENTRAL FWY APT 802
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-1344
Mailing Address - Country:US
Mailing Address - Phone:801-664-4285
Mailing Address - Fax:
Practice Address - Street 1:527 TUSKEGEE AIRMEN AVE BUILDING #500
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist