Healthcare Provider Details

I. General information

NPI: 1124352786
Provider Name (Legal Business Name): PAULA A. WALKER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD CALVERT COMMUNITY DENTAL
PRINCE FREDERICK MD
20678-4017
US

IV. Provider business mailing address

100 HOSPITAL RD KEEPWELL CENTER
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-8402
  • Fax: 410-535-8397
Mailing address:
  • Phone: 410-535-8402
  • Fax: 410-535-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: