Provider Demographics
NPI:1295893253
Name:VERONICA S WALKER DDS PLLC
Entity type:Organization
Organization Name:VERONICA S WALKER DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:SIAFACAS
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-993-3727
Mailing Address - Street 1:428 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-993-3727
Mailing Address - Fax:336-993-3918
Practice Address - Street 1:428 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-993-3727
Practice Address - Fax:336-993-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890289EMedicaid
NC0289OtherBCBSNC