Provider Demographics
NPI:1780316745
Name:JULIAN, WALTER CLARK (DDS)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:CLARK
Last Name:JULIAN
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 1:2540 S SAN TAN VILLAGE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0301
Mailing Address - Country:US
Mailing Address - Phone:480-892-5089
Mailing Address - Fax:
Practice Address - Street 1:2540 S SAN TAN VILLAGE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0301
Practice Address - Country:US
Practice Address - Phone:480-892-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0114721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice