Provider Demographics
NPI:1851303572
Name:WALKER, JOAN ROULSTON (DDS)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ROULSTON
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:ROULSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4025 NE LAKEWOOD WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064
Mailing Address - Country:US
Mailing Address - Phone:816-795-5626
Mailing Address - Fax:816-795-5629
Practice Address - Street 1:4025 NE LAKEWOOD WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-795-5626
Practice Address - Fax:816-795-5629
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO15528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist