Provider Demographics
NPI:1922112804
Name:WALKER, HARRISON CARROLL JR (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:CARROLL
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:311 E GILLESPIE ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3303
Mailing Address - Country:US
Mailing Address - Phone:662-323-6921
Mailing Address - Fax:662-323-9727
Practice Address - Street 1:100 BRANDON RD
Practice Address - Street 2:SUITE W
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2571
Practice Address - Country:US
Practice Address - Phone:662-323-9726
Practice Address - Fax:662-323-9727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO-006-741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00063365Medicaid
MS09205284Medicaid