Provider Demographics
NPI:1922279892
Name:TODD K. WALKER, DDS, PC
Entity Type:Organization
Organization Name:TODD K. WALKER, DDS, PC
Other - Org Name:RIVER CITY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:208-853-8811
Mailing Address - Street 1:7723 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6182
Mailing Address - Country:US
Mailing Address - Phone:208-853-8811
Mailing Address - Fax:208-853-2495
Practice Address - Street 1:7723 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6182
Practice Address - Country:US
Practice Address - Phone:208-853-8811
Practice Address - Fax:208-853-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD35861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty