Provider Demographics
NPI:1407857279
Name:WALKER, MARK V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:V
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 1:422 E SMITH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4546
Mailing Address - Country:US
Mailing Address - Phone:253-852-3033
Mailing Address - Fax:253-852-1845
Practice Address - Street 1:422 E SMITH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4546
Practice Address - Country:US
Practice Address - Phone:253-852-3033
Practice Address - Fax:253-852-1845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice