Provider Demographics
NPI:1700919727
Name:WALKLEY, CHARLES S (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:WALKLEY
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 1:527 LONG POND DR
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645
Mailing Address - Country:US
Mailing Address - Phone:508-430-0505
Mailing Address - Fax:508-430-0918
Practice Address - Street 1:527 LONG POND DR
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645
Practice Address - Country:US
Practice Address - Phone:508-430-0505
Practice Address - Fax:508-430-0918
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice