Provider Demographics
NPI:1215188370
Name:WALKER ORTHODONTICS PC
Entity Type:Organization
Organization Name:WALKER ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-345-7988
Mailing Address - Street 1:119 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1214
Mailing Address - Country:US
Mailing Address - Phone:978-345-7988
Mailing Address - Fax:978-345-1191
Practice Address - Street 1:119 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1214
Practice Address - Country:US
Practice Address - Phone:978-345-7988
Practice Address - Fax:978-345-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX04572OtherBCBS
MA723144OtherTUFTS
MA9758313Medicaid