Provider Demographics
NPI:1245427798
Name:WALKER, LAWRENCE DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DANIEL
Last Name:WALKER
Suffix:
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 1:113 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1198
Mailing Address - Country:US
Mailing Address - Phone:231-873-2920
Mailing Address - Fax:231-873-8302
Practice Address - Street 1:113 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1198
Practice Address - Country:US
Practice Address - Phone:231-873-2920
Practice Address - Fax:231-873-8302
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010109341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice