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General NPI Number Information
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NPI Number | 1356484844
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Entity Type | Organization
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Legal Business Name | MITCHELL WALKER DDS, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708B PALUXY ROAD
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City | GRANBURY
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State | TX
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Zip | 76048-2396
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Country | US
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Telephone | 817-573-2622
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Fax | 817-579-0142
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Provider Business Mailing Address
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Address Line | 708B PALUXY ROAD
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City | GRANBURY
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State | TX
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Zip | 76048-2396
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Country | US
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Telephone | 817-573-2622
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Fax | 817-579-0142
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Authorized Official
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Title or Position | OWNER
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Name | DR. MITCHELL WALKER
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Credential | D.D.S.
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Telephone | 817-573-2622
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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 | 9266
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License Number State | TX
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