Healthcare Provider Details

I. General information

NPI: 1588668909
Provider Name (Legal Business Name): CARLTON N WALKER D.D.S.,P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W COUNTRY CLUB RD STE 6
ROSWELL NM
88201-5804
US

IV. Provider business mailing address

313 W COUNTRY CLUB RD STE 6
ROSWELL NM
88201-5804
US

V. Phone/Fax

Practice location:
  • Phone: 505-622-3300
  • Fax: 505-625-9018
Mailing address:
  • Phone: 505-622-3300
  • Fax: 505-625-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number848
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: