MEDICARE: DR. KYLE ARCHER WALK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS022450L	PA

General Provider Information

NPI Number	:	1043446214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE ARCHER WALK D.M.D.

Provider Business Mailing Address
First Line	:	510 RICHLAND AVE
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1013
Country	:	US
Telephone Number	:	412-466-4347
Fax Number	:	412-466-7720

Provider Business Practice Location Address
First Line	:	510 RICHLAND AVE
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1013
Country	:	US
Telephone Number	:	412-466-4347
Fax Number	:	412-466-7720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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