Provider Demographics
NPI:1417383761
Name:S. DESIREE WALKER, DDS, PA
Entity Type:Organization
Organization Name:S. DESIREE WALKER, DDS, PA
Other - Org Name:LUMBER RIVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-474-2587
Mailing Address - Street 1:219 CHARMANT RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2131
Mailing Address - Country:US
Mailing Address - Phone:910-474-2587
Mailing Address - Fax:
Practice Address - Street 1:3718 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:919-360-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty