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General NPI Number Information
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NPI Number | 1669414462
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Entity Type | Organization
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Legal Business Name | BRIAN G WALKER DDS PC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6470 N SHADELAND AVENUE STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4386
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Country | US
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Telephone | 317-842-2345
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Fax | 317-842-3115
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Provider Business Mailing Address
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Address Line | 6470 N SHADELAND AVENUE STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4386
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Country | US
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Telephone | 317-842-2345
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Fax | 317-842-3115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN G WALKER
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Credential | DDS
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Telephone | 317-842-2345
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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 | 12009527
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License Number State | IN
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