Provider Demographics
NPI:1205040680
Name:WALKER, CHARLES CLAYTON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLAYTON
Last Name:WALKER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 JUNCTION PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2263
Mailing Address - Country:US
Mailing Address - Phone:910-350-6944
Mailing Address - Fax:910-392-3023
Practice Address - Street 1:4405 JUNCTION PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2263
Practice Address - Country:US
Practice Address - Phone:910-350-6944
Practice Address - Fax:910-392-3023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90020OtherBCBS
NC822360OtherUNITED CONCORDIA
NC8990020Medicaid