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General NPI Number Information
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NPI Number | 1992794820
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Entity Type | Individual
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Provider Name | IAN JACOB WALKER DDS
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2000 EGGERT RD
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City | AMHERST
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State | NY
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Zip | 14226-2139
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Country | US
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Telephone | 716-836-2844
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Fax | 716-836-1830
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Provider Business Mailing Address
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Address Line | 3450 SWEET HOME RD
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City | AMHERST
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State | NY
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Zip | 14228-1335
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Country | US
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Telephone | 716-316-1425
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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 | 049040
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License Number State | NY
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