MEDICARE: DR. RONALD WALKER JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	63548	CA
2	1223G0001X	General Practice Dentistry	019.033541	IL

General Provider Information

NPI Number	:	1356749311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WALKER JR. DDS

Provider Business Mailing Address
First Line	:	1860 N RICHMOND RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60051-5416
Country	:	US
Telephone Number	:	224-347-3475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 N RICHMOND RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60051-5416
Country	:	US
Telephone Number	:	224-347-3575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	06/21/2022

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