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General NPI Number Information
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NPI Number | 1154052090
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Entity Type | Individual
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Provider Name | CARL WALKER PRINCE DMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 527 TUSKEGEE AIRMEN AVE BUILDING #500
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1847
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 CENTRAL FWY APT 802
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City | WICHITA FALLS
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State | TX
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Zip | 76306-1344
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Country | US
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Telephone | 801-664-4285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27090
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License Number State | FL
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