Provider Demographics
NPI:1134246481
Name:WALKER, THOMAS HOWARD (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HOWARD
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 LANARKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8261
Mailing Address - Country:US
Mailing Address - Phone:317-859-9266
Mailing Address - Fax:317-888-0752
Practice Address - Street 1:488 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1424
Practice Address - Country:US
Practice Address - Phone:317-888-9470
Practice Address - Fax:317-888-0752
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice