Provider Demographics
NPI:1679646335
Name:WALKER, GLORIANNE D (DMD PLLC)
Entity Type:Individual
Prefix:DR
First Name:GLORIANNE
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:DMD PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 737
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354
Mailing Address - Country:US
Mailing Address - Phone:253-922-6822
Mailing Address - Fax:
Practice Address - Street 1:5615 VALLEY AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98424-2060
Practice Address - Country:US
Practice Address - Phone:253-922-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice