Provider Demographics
NPI:1346453800
Name:WALKER, TODD K (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:K
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 1:5125 N RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1997
Mailing Address - Country:US
Mailing Address - Phone:208-906-1486
Mailing Address - Fax:
Practice Address - Street 1:7723 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6182
Practice Address - Country:US
Practice Address - Phone:208-853-8811
Practice Address - Fax:208-853-2495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD35861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice