Provider Demographics
NPI:1003427519
Name:WALLING, VICTORIA TAYLOR (DDS)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TAYLOR
Last Name:WALLING
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 POTRANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9601
Mailing Address - Country:US
Mailing Address - Phone:210-680-8080
Mailing Address - Fax:
Practice Address - Street 1:9514 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9601
Practice Address - Country:US
Practice Address - Phone:210-680-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT193891223G0001X
TX37257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice