MEDICARE: J WALKER DENTAL CORPORATION

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1427541168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J WALKER DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1305 GARIBALDI CT
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 E ELDER ST STE 203
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3083
Country	:	US
Telephone Number	:	208-800-1239
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY WALKER
Credential	:	DMD
Telephone Number	:	208-800-1239

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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