Healthcare Provider Details

I. General information

NPI: 1811589732
Provider Name (Legal Business Name): DYLAN ROBERT WALKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PEACHTREE PKWY STE 4250
CUMMING GA
30041-7569
US

IV. Provider business mailing address

2904 STRATFORD DR
AUGUSTA GA
30909-3528
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-7069
  • Fax:
Mailing address:
  • Phone: 404-798-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN122486
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: