Provider Demographics
NPI:1528575727
Name:EDWARD WALK DMD PC
Entity Type:Organization
Organization Name:EDWARD WALK DMD PC
Other - Org Name:COSDENT.COM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:WALK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-965-3225
Mailing Address - Street 1:64 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1439
Mailing Address - Country:US
Mailing Address - Phone:617-965-3225
Mailing Address - Fax:617-965-7501
Practice Address - Street 1:64 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1439
Practice Address - Country:US
Practice Address - Phone:617-965-3225
Practice Address - Fax:617-965-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN11893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty