Provider Demographics
NPI:1295041093
Name:CENTRAL INDIANA ORAL SURGERY AND IMPLANTOLOGY
Entity Type:Organization
Organization Name:CENTRAL INDIANA ORAL SURGERY AND IMPLANTOLOGY
Other - Org Name:WALKER ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-844-9888
Mailing Address - Street 1:272 MEDICAL DR.
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-844-9888
Mailing Address - Fax:317-844-1719
Practice Address - Street 1:272 MEDICAL DR.
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-844-9888
Practice Address - Fax:317-844-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011016A204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty