Healthcare Provider Details

I. General information

NPI: 1124237292
Provider Name (Legal Business Name): GARY L. WALKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 FOREST AVE.
CHICO CA
95928
US

IV. Provider business mailing address

2533 FOREST AVE.
CHICO CA
95928
US

V. Phone/Fax

Practice location:
  • Phone: 530-895-1244
  • Fax: 530-342-5601
Mailing address:
  • Phone: 530-895-1244
  • Fax: 530-342-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21662
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: