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General NPI Number Information
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NPI Number | 1235834003
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Entity Type | Individual
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Provider Name | MASON LEE WALKER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1001 GIBSON BAY DR STE 202
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City | RICHMOND
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State | KY
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Zip | 40475-3544
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Country | US
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Telephone | 859-625-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 GRAY HAWK RD APT B
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City | LEXINGTON
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State | KY
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Zip | 40502-7011
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Country | US
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Telephone | 859-699-6935
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10930
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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