Provider Demographics
NPI:1386815488
Name:JUDITH A. WALKER DDS, PA
Entity Type:Organization
Organization Name:JUDITH A. WALKER DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-275-1472
Mailing Address - Street 1:1317 N ELM ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1033
Mailing Address - Country:US
Mailing Address - Phone:336-275-1472
Mailing Address - Fax:336-275-2962
Practice Address - Street 1:1317 N ELM ST
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1033
Practice Address - Country:US
Practice Address - Phone:336-275-1472
Practice Address - Fax:336-275-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty