=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588722532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA SIAFACAS WALKER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 W MOUNTAIN ST
-----------------------------------------------------
City | KERNERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27284-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-993-3727
-----------------------------------------------------
Fax | 336-993-3918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 W MOUNTAIN ST
-----------------------------------------------------
City | KERNERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27284-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-993-3727
-----------------------------------------------------
Fax | 336-993-3918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5334
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------