Healthcare Provider Details

I. General information

NPI: 1033271226
Provider Name (Legal Business Name): CURTIS JON VANDEWALKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 KING RD STE B
LOOMIS CA
95650-8877
US

IV. Provider business mailing address

6135 KING RD STE B
LOOMIS CA
95650-8877
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-5863
  • Fax: 916-652-5338
Mailing address:
  • Phone: 916-652-5863
  • Fax: 916-652-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDL028402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: