Provider Demographics
NPI:1982632386
Name:WALKER, ANDREW JACKSON JR (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JACKSON
Last Name:WALKER
Suffix:JR
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 1:1320 HIGHWAY 9 BYPASS
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-4712
Mailing Address - Country:US
Mailing Address - Phone:803-283-9998
Mailing Address - Fax:803-283-9997
Practice Address - Street 1:1320 HIGHWAY 9 BYPASS
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4712
Practice Address - Country:US
Practice Address - Phone:803-283-9998
Practice Address - Fax:803-283-9997
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2518Medicaid