Provider Demographics
NPI:1699185793
Name:MARK S WALKER LLC
Entity Type:Organization
Organization Name:MARK S WALKER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-235-0449
Mailing Address - Street 1:285 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2773
Mailing Address - Country:US
Mailing Address - Phone:856-235-0449
Mailing Address - Fax:856-235-6988
Practice Address - Street 1:285 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2773
Practice Address - Country:US
Practice Address - Phone:856-235-0449
Practice Address - Fax:856-235-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty