Provider Demographics
NPI:1700983723
Name:PENDARVIS, WALKER THOMAS (DMD, MHS)
Entity Type:Individual
Prefix:
First Name:WALKER
Middle Name:THOMAS
Last Name:PENDARVIS
Suffix:
Gender:M
Credentials:DMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 ABERCORN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5800
Mailing Address - Country:US
Mailing Address - Phone:912-349-3259
Mailing Address - Fax:912-358-0008
Practice Address - Street 1:6600 ABERCORN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5800
Practice Address - Country:US
Practice Address - Phone:912-349-3259
Practice Address - Fax:912-358-0008
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3953122300000X
SC06461223P0300X
GADN013482122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist