Provider Demographics
NPI:1730296054
Name:WALKER, TABREENA V M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TABREENA
Middle Name:V M
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:761ST TANK BATTALION
Mailing Address - Street 2:BLDG 330
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-2079
Mailing Address - Country:US
Mailing Address - Phone:254-285-2014
Mailing Address - Fax:254-285-2182
Practice Address - Street 1:761ST TANK BATTALION
Practice Address - Street 2:BLDG 330
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-2079
Practice Address - Country:US
Practice Address - Phone:254-285-2014
Practice Address - Fax:254-285-2182
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX205781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI 284661001Medicaid
TXB20578-01OtherTEXAS CHIP DENTAL SERVICES