Provider Demographics
NPI:1245755669
Name:WALKER, AJA DANIELLE
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:DANIELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 SUMMERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3901
Mailing Address - Country:US
Mailing Address - Phone:214-601-7553
Mailing Address - Fax:
Practice Address - Street 1:1933 N CENTRAL EXPY STE 520
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3685
Practice Address - Country:US
Practice Address - Phone:214-601-7553
Practice Address - Fax:214-601-7553
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice