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General NPI Number Information
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NPI Number | 1912194572
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Entity Type | Individual
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Provider Name | JEFFREY T. WALKER D.D.S.,M.S.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 540 BUTTERNUT TRL
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City | FRANKFORT
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State | IL
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Zip | 60423-1076
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Country | US
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Telephone | 630-865-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 18130 HALSTED ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2507
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Country | US
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Telephone | 708-799-2550
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Fax | 708-799-1094
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021-001705
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License Number State | IL
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