Provider Demographics
NPI:1942468590
Name:WALKER, KHALFANI DUME (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHALFANI
Middle Name:DUME
Last Name:WALKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 GEORGIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-7638
Mailing Address - Country:US
Mailing Address - Phone:301-933-5175
Mailing Address - Fax:
Practice Address - Street 1:11175 GEORGIA AVE STE A
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-7638
Practice Address - Country:US
Practice Address - Phone:301-933-5175
Practice Address - Fax:301-933-5186
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053671-11223G0001X
MD14525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice