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General NPI Number Information
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NPI Number | 1558884742
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Entity Type | Individual
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Provider Name | BLAKE WALKER RICHARD DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 2947 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75227-6952
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Country | US
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Telephone | 214-381-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 ROBIN RD
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City | PLANO
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State | TX
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Zip | 75075-7908
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Country | US
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Telephone | 318-267-4479
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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 | 33338
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License Number State | TX
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