Provider Demographics
NPI:1518229376
Name:WALKER, CHARLENE NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MCRAE BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6706
Mailing Address - Country:US
Mailing Address - Phone:915-592-4168
Mailing Address - Fax:
Practice Address - Street 1:1800 MCRAE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6706
Practice Address - Country:US
Practice Address - Phone:915-592-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry