Healthcare Provider Details

I. General information

NPI: 1255578134
Provider Name (Legal Business Name): ROBERT A WALKER RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE CMR 402
APO AE
09180
US

IV. Provider business mailing address

LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE CMR 402
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 011496371929130
  • Fax: 011496371929117
Mailing address:
  • Phone: 011496371929130
  • Fax: 011496371929117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0008376
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402002672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: