Provider Demographics
NPI:1871512079
Name:WALKER DENTISTRY P.C.
Entity Type:Organization
Organization Name:WALKER DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-849-8550
Mailing Address - Street 1:10177 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2014
Mailing Address - Country:US
Mailing Address - Phone:317-849-8550
Mailing Address - Fax:317-841-0121
Practice Address - Street 1:10177 ALLISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2014
Practice Address - Country:US
Practice Address - Phone:317-849-8550
Practice Address - Fax:317-841-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200210290AMedicaid