Healthcare Provider Details

I. General information

NPI: 1043214059
Provider Name (Legal Business Name): DEE ANNA WALKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEE ANNA NICHOLS DDS

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SOUTH AVENUE Q
CLIFTON TX
76634
US

IV. Provider business mailing address

P.O. BOX 366
CLIFTON TX
76634
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-3518
  • Fax: 254-675-1262
Mailing address:
  • Phone: 254-675-3518
  • Fax: 254-675-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberN15582
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: