Provider Demographics
NPI:1396400834
Name:WALKER, QUINCY RAGLAN RENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUINCY
Middle Name:RAGLAN RENE
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 1:320 JACKSON HILL ST APT 155
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7447
Mailing Address - Country:US
Mailing Address - Phone:337-396-7218
Mailing Address - Fax:
Practice Address - Street 1:2313 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3859
Practice Address - Country:US
Practice Address - Phone:337-396-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist