=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417169707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKER DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 LONGTOWN ROAD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-865-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 N WOODLAKE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29229-8919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-865-9919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COOWNER
-----------------------------------------------------
Name | DR. LEE ANDERSON WALKER
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 803-865-9919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3984
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4038
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------