Provider Demographics
NPI:1437161890
Name:WALKER, TRACY DEAN (DDS MS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DEAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 S LEE HWY UNIT 22
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5786
Mailing Address - Country:US
Mailing Address - Phone:805-794-5842
Mailing Address - Fax:
Practice Address - Street 1:7808 MAHAN GAP RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5708
Practice Address - Country:US
Practice Address - Phone:805-794-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030018Medicaid