MEDICARE: DR. WM G WALKER D.D.S.

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	DS003267	TN

General Provider Information

NPI Number	:	1538170725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WM G WALKER D.D.S.

Provider Business Mailing Address
First Line	:	755 BROAD ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-2248
Country	:	US
Telephone Number	:	423-479-4169
Fax Number	:	423-479-4503

Provider Business Practice Location Address
First Line	:	755 BROAD ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-2248
Country	:	US
Telephone Number	:	423-479-4169
Fax Number	:	423-479-4503

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/27/2023

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