Provider Demographics
NPI:1720194616
Name:WALKER, CAROLYN BOWMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BOWMAN
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 1:25235 W INTERSTATE 10
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9550
Mailing Address - Country:US
Mailing Address - Phone:210-698-1010
Mailing Address - Fax:210-698-1078
Practice Address - Street 1:25235 W INTERSTATE 10
Practice Address - Street 2:SUITE # 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9550
Practice Address - Country:US
Practice Address - Phone:210-698-1010
Practice Address - Fax:210-698-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743024934OtherTAX ID NUMBER