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General NPI Number Information
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NPI Number | 1598962003
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Entity Type | Organization
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Legal Business Name | JOAN R. WALKER, DDS, PC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4025 NE LAKEWOOD WAY STE 200
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1995
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Country | US
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Telephone | 816-795-5626
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 NE LAKEWOOD WAY STE 200
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1995
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Country | US
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Telephone | 816-795-5626
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOAN ROULSTON WALKER
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Credential | D.D.S.
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Telephone | 816-795-5626
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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 | MO015528
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License Number State | MO
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