=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386815488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH A. WALKER DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 03/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1317 N ELM ST SUITE 6
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-1472
-----------------------------------------------------
Fax | 336-275-2962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1317 N ELM ST SUITE 6
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-1472
-----------------------------------------------------
Fax | 336-275-2962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUDY A WALKER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 336-275-1472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6281
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------